Beauty Services Consent Form

Beauty Services Consent Form

Client Name:    Date of Birth:

Client Information

Appointment Date:    Time:

Services Requested

Please check all services to be performed:

Haircut    Hair Color/Highlights    Chemical Treatment (perm/relaxer)    Keratin/Smoothing

Facial    Waxing/Threading    Manicure/Pedicure    Eyelash Extensions/Lifts

Medical History & Contraindications

Do you have any known allergies (cosmetics, latex, medication, food)? Yes No

Are you currently taking any prescription medications, topical treatments, or using isotretinoin (Accutane) within the past 6–12 months? Yes No

Do you have any of the following conditions? (check all that apply)

Diabetes    Heart Condition    Bleeding Disorder    Autoimmune Disorder

Active Skin Disorder (eczema, psoriasis, dermatitis)    Active Infection or Open Wounds

Are you pregnant or breastfeeding? Yes No

Patch Test and Chemical Procedures

Certain color, chemical, peeling, and adhesive-based treatments may cause adverse reactions. A patch test is recommended at least 48 hours prior to service for chemical/color procedures. I consent to a patch test when required and acknowledge that a negative patch test does not guarantee absence of future reaction.

I consent to a patch test: Yes    No

Risks, Aftercare & Acknowledgment

I understand that all beauty services carry inherent risks including, but not limited to: allergic reactions, irritation, redness, swelling, burns, scarring, infection, uneven results, color variation, and damage to hair or skin. Results cannot be guaranteed. I agree to follow aftercare instructions provided by the practitioner and understand that failure to follow aftercare may adversely affect results.

I acknowledge that I have read and understand the risks and aftercare instructions: Initial/Check to acknowledge

Payment Terms & Cancellation

Estimated Service Fee: $    Deposit Required: $

Cancellation notice required: . Late cancellation or no-show may result in forfeiture of deposit or additional fee.

Late fee or finance charge for unpaid balances:

Confidentiality & Photographs

Client information, medical history, and treatment records will be maintained confidentially in accordance with applicable law and salon policies. With my consent, the practitioner may take photographs of the treated area for treatment records, education, or promotional use. Photographs will not include identifying information unless expressly authorized.

I consent to clinical photographs: Yes    No

Consent and Release

By signing below I certify that all information provided on this form is true and complete to the best of my knowledge. I authorize the practitioner to perform the requested services and to take such actions as may be necessary for treatment related to those services. I release the salon, practitioner, and their agents from liability for any adverse outcomes resulting from services rendered, except where caused by gross negligence or willful misconduct. I understand that certain results cannot be guaranteed and that additional treatments may be required.

I further state that I am at least 18 years of age or, if under 18, that I am the parent or legal guardian authorizing treatment for the minor and accept full responsibility for payment and consent.

Governing Law & Entire Agreement

This Consent Form and any dispute arising from services performed hereunder shall be governed by the laws of the state applicable to the salon location. This document constitutes the entire agreement between the client and the salon regarding the services described and supersedes all prior understandings and agreements, whether written or oral.

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