Hair Texture Relaxation Service Consent Form
Please read and complete all sections to provide your consent for the hair texture relaxation service.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Appointment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Do you have any allergies or medical conditions we should be aware of?
*
No, I do not have any allergies or medical conditions related to hair treatments.
Yes, I have allergies or medical conditions (please specify below).
If yes, please specify your allergies or medical conditions:
Have you had any previous chemical treatments on your hair in the last 6 months?
*
Yes
No
Signature (Please sign below to provide your consent)
*
Submit Consent Form
Submit Consent Form
Should be Empty: