Brazilian Blowout Consent Form

I have received a hair analysis and consultation with a curl and Keratin Treatment specialist.

I have provided all information regarding previous treatments to my curl and/ or color.

My stylist has explained to me the process recommended for my hair type, texture, condition and desired results.

I have been given aftercare instructions and product recommendations to best care for, preserve, and prolong my treatment results. I understand that if I do not use the recommended home products, I will not see the desired results.

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I am not pregnant or nursing

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I understand that keratin smoothing Treatments are semi-permanent curl relaxers which greatly reduce frizz, bulk and curl. Results vary and I have been advised as to the results I personally can expect from this treatment and how to maintain it. Keratin smoothing treatments can produce fumes which may cause irritations in some sensitive individuals. My treatment does NOT contain Formaldehyde, but does contain one of the following:

Organic Aldehyde Glutaraldehyde No Hyde family ingredients

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The service will be performed in a ventilated area and I have been offered the option of a towel or shield for my eyes and face should they become sensitive.

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I have read, understand, and fully agree to the terms of this Waiver and Release Form. I understand and confirm that by signing this form, I hereby waive and release Practically Perfect Day Spa and Salon and its employee(s) of and from any and all claims, damages and liabilities, of every kind and nature, arising from or in any way related to the services being provided to me by Practically Perfect Day Spa and Salon.

Signee Information

First Name *

Last Name *

Your Date of Birth *

Phone *

Email Address

Address *

Address Line 2

City *

State *

Zip *

Emergency Contact:

List any allergies or medications.

When was your last hair service?

What results are you looking for from your visit?

Do you currently have any at home/box color on your hair?

When was the last time you used a "box" color on your hair?

What hair products are you currently using and how often?

How would you describe your hair? E.g. healthy, dry, thick, thin, thinning, greasy, frizzy, curly, smooth, straight, damaged, etc...

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By clicking 'I Agree' below, you agree that you have read and agree with the terms of the waiver and that the information you provided is accurate. You furthermore agree that your submission of this form, via the 'I Agree' button, shall constitute the execution of this document in exactly the same manner as if you had signed, by hand, a paper version of this agreement.