Client Information

Full Name: *

Date of Birth: *

Phone Number: *

Email Address: *

Address: (Optional)

Medical & Hair History

Please provide the following information:

Allergies & Sensitivities:

I have no known allergies to hair dyes, chemicals, or related products.

I have known allergies or sensitivities (please specify):

Scalp & Skin Conditions:

I have no scalp conditions (e.g., eczema, psoriasis, dermatitis).

I have a scalp condition (please describe):

Previous Hair Treatments:

I have not experienced adverse reactions to previous hair coloring or chemical treatments.

I have experienced reactions in the past (please describe):

Current Hair Condition:

My hair is in good condition and healthy.

My hair has been previously treated (bleached, colored, or chemically processed). If yes, please list treatments:

Procedure Information & Risks

Hair colour balayage is a specialized hair coloring technique that creates a natural, sun-kissed look through a freehand application process. I understand that:

Process Details:

• The stylist will apply both color and lightener freehand to achieve a graduated, blended effect.

• A patch or strand test may be performed to determine product compatibility and desired results.

• The outcome may vary based on the current condition, texture, and history of your hair.

Potential Risks & Limitations:

• Temporary scalp irritation, redness, or discomfort during and immediately after the process.

• Hair dryness, damage, or breakage if the hair is over-processed or if pre-existing damage is present.

• Color variations and unexpected results due to the natural variability of hair and previous treatments.

• The possibility of uneven color or the need for additional sessions/touch-ups for desired results.

• Color fading over time, requiring maintenance treatments to preserve vibrancy.

Aftercare:

• I have received instructions on proper post-treatment care, including recommended hair care products and maintenance routines.

• I understand that avoiding excessive heat styling and using color-protecting shampoos and conditioners can help prolong results.

Consent & Acknowledgment

I acknowledge that: *

I have provided complete and accurate information regarding my medical history, allergies, and hair condition.

I understand the nature of the hair colour balayage procedure, including the process, potential benefits, risks, and limitations.

I have been informed that results vary from person to person and that multiple sessions or touch-ups might be required to achieve my desired outcome.

I agree to follow all pre- and post-treatment care instructions provided by my stylist.

I consent to the hair colour balayage treatment and accept any potential risks involved.

By signing below, I confirm that I have read and understood the information provided and consent to proceed with the hair colour balayage/ high lights treatment.

Client Name: *

Client Signature: *

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Date: *

Stylist/Practitioner Name (Print): *

Stylist/Practitioner Signature: *

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Date: *

I agree to terms & conditions provided by the company.

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