Salon Service Consultation & Liability Waiver "*" indicates required fields EmailThis field is for validation purposes and should be left unchanged.Client InformationFull Name*Phone Number*Email* Date of Birth* MM slash DD slash YYYY Appointment Date* MM slash DD slash YYYY Hair ConsultationService Requested Natural Hair Service Silk Press Protective Style Sew-In/Extensions Wig Install Color Service Relaxer/Texturizer Treatment Service Other OtherHair Goals & PreferencesDesired Style/ServiceDesired Results Length Volume Color Change Healthy Hair Maintenance Protective Styling Other OtherNormalDryOilyCombinationSensitiveHair HistoryCurrent Hair Type/TextureOtherCurrent Hair Concerns Dryness Breakage Thinning Shedding Damage Scalp Concerns None How often do you receive salon services? Weekly Monthly Every few months Rarely Previous Chemical Services Relaxer Color Bleach Keratin/Smoothing Treatment Perm/Texturizer None Date of last chemical service MM slash DD slash YYYY Have you had any previous reactions to hair products or chemicals? No Yes Please explainScalp & Health QuestionnaireDo you currently have Sensitive scalp Eczema Psoriasis Open cuts/sores Scalp irritation Hair loss concerns None Are you currently taking any medications or treatments that affect your hair/scalp? No Yes Please explainDo you have any allergies or sensitivities to Hair color Relaxers Hair products Adhesives/glue Latex Oils/fragrances Other OtherExtension/Wig Consultation (If Applicable)Have you worn extensions before? Yes No Preferred extension type K-Tip I-Tip Sew-In Wig Install Other OtherColor Service Consultation (If Applicable)Current Hair ColorDesired ColorPrevious Color History Box Color Professional Color Bleach Color Correction None I understand that achieving certain colors may require multiple sessions.Client Acknowledgment & Consent I understand that salon services are customized based on my hair type, condition, history, and desired results. I understand that results may vary depending on my hair’s current condition, previous services, lifestyle, and aftercare. I acknowledge that: I have provided accurate information about my hair history and health concerns. I have disclosed all allergies, sensitivities, medications, and previous reactions. Chemical services may cause irritation, dryness, breakage, or unexpected results. Extensions and protective styles may cause tension or discomfort if not properly maintained. Proper aftercare is necessary to maintain healthy hair and desired results. Additional services may be recommended based on consultation findings. Liability Release I voluntarily consent to receive salon services from K&M Dew Glam Lounge. I release and hold harmless K&M Dew Glam Lounge, its stylists, employees, and representatives from liability for allergic reactions, scalp sensitivity, hair damage, color variations, extension-related concerns, or other outcomes resulting from undisclosed information, improper aftercare, or individual hair response. I understand that my stylist will provide professional recommendations based on my consultation, but final results cannot be guaranteed.Photo & Marketing ConsentMay K&M Dew Glam Lounge use photos/videos of your finished service for portfolio, website, and social media? Yes, I authorize use No, I do not authorize use Client SignatureClient SignatureStylist SignatureDate MM slash DD slash YYYY Date MM slash DD slash YYYY
