KERATIN CONSULTATION & CONSENT

CLIENT DETAILS

Full Name *

Phone Number *

Email Address *

Date of appointment:

Stylist:

HAIR HISTORY & CONSULTATION

Chemical services in the last 12 months (colour, bleach, perm, relaxer, straightening):

Previous keratin/smoothing treatment and date:

Any known allergies, previous reactions, scalp irritation, or relevant sensitivities? If yes, details:

Any current scalp cuts, sores or inflammation?

Yes

No

Pregnant or breastfeeding (optional disclosure, for product suitability discussion)?

Yes

No

Prefer not to say

TREATMENT PLAN - TO BE COMPLETED BY STYLIST

Product / system:

Strand test completed?

Yes

No

Result

Patch / allergy assessment if required by product instructions:

Proposed temperature / passes (per manufacturer protocol):

Desired result / limitations discussed:

IMPORTANT INFORMATION - PLEASE READ

I understand that this is a cosmetic smoothing/frizz-reduction service. Results and longevity vary with hair history, texture, porosity, aftercare and the specific product used. Smoother-looking hair is not proof that existing hair damage has been repaired.

I understand that artificial hair colour or toner may fade or shift during treatment, including blonde becoming warmer/yellower and brunette becoming warmer/coppery. Heat may increase this risk. Colour correction or toning may be a separate service and charge.

I understand that chemical products and heat can cause irritation, dryness, breakage or other adverse reactions, particularly on compromised hair. A strand test helps assess risk but cannot guarantee a result. I will tell my stylist immediately if I feel burning, breathing discomfort or irritation.