Hair By Blondiebourgeois'

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Chemical Consultation Checklist

Email *

Name *

Date *

YYYY

What is your hair texture?

Fine

Course

Normal

Clear selection

Describe your answer above?

What challenges do you deal with in regards to your hair texture? (fly aways, frizzy, un-managable, flat)

What texture service are you wanting today?

Chemical Smoothing (Brazillian blowout, Keratin, Incaglow)

Permanent Straightening (Relaxer)

Curls (Perm)

Clear selection

When was your last chemical service? (color, highlight, relaxer, smoothing, perm)

YYYY

Describe the service above.

Depending on the service you choose, almost all of them will require specific home care and regular visits to the salon. Do you have concerns about that?

Yes

No, I'm clear on the results I wish to achieve.

Clear selection

Do you understand that failure to disclose any previous chemical services that have been applied to your hair in the last 3-6 months, can have a negative result on your service today?

Yes

Clear selection

Do you have any sensitivity, abrasions, trauma on your scalp?

Yes

Clear selection

If yes, please explain:

Have you experienced any hair loss that could be considered unusual?

Yes

Clear selection

If yes, please explain:

Chemical disclosure

The services you are requesting will actually go in to the structure of your hair strands and change them permanently. There is no quick fix for undesired results. Strand test will be performed and a decision to proceed will be based on the integrity of your hair. You understand that failure to use professional products will void the warranty on this service. Products that are bought in a drug store (even if they say they are professional) or online (amazon or ebay) are not guaranteed. You should buy your products from a reputable salon. We have a wide variety of products to maintain the service you are about to receive. We do not take any responsibility for any chemical service or color service you may have immediate following this service at this salon, another salon, or at home. Chemically treated hair requires treatments and rest prior to applying any other chemical service.

If you have read the disclosure above and agree to it's terms, please check below. *

Yes, I have read the above disclosure, had the opportunity to ask questions, had a product recommendation and agree to proceed with services today.

No, I still have concerns and choose to schedule services at a later date.

Required

If you agreed to continue, please indicate what product you plan to use for your shampoo & conditioning at home.

Send me a copy of my responses.

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