1. Client Contact and Identification
Full Legal Name: [[Client Full Legal Name]]
Preferred Name (if different): [[Preferred Name]]
Date of Birth: [[MM/DD/YYYY]]
Phone: [[Client Primary Phone]]
Email: [[Client Email]]
Home Address: [[Street, City, State, ZIP]]
Emergency Contact Name & Relationship: [[Name]] / [[Relationship]]
Emergency Contact Phone: [[Phone Number]]
How did you hear about us: [[Referral Source or Marketing Channel]]
2. Service and Goal Information
List the specific service(s) you are receiving today and your desired outcome:
[[Detailed description of requested services and goals, e.g. "Full highlight with root touch-up, length trim, and style for shoulder-length hair. Goal: natural blended color with healthy shine."]]
Previous services received at this or other salons in the last 6 months: [[List prior services, dates, and any issues]]
Current hair / skin / nail condition and concerns: [[Describe current state and goals]]
3. General Health Screening and Medical History
Answer all questions accurately. Certain conditions may require modified protocols, patch testing, physician clearance, or service deferral.
- Are you currently under the care of a physician or dermatologist for any skin, scalp, or medical condition? [[Yes / No - details if yes]]
- Are you pregnant, nursing, or trying to conceive? [[Yes / No]]
- Do you have any allergies (food, environmental, latex, metals, fragrances, adhesives, dyes, resins)? [[List all or "None known"]]
- List all current medications, supplements, and topical products (including retinoids, acids, antibiotics, blood thinners, Accutane within last 6-12 months): [[Full list or "None"]]
- Do you have a history of skin cancer, keloid scarring, eczema, psoriasis, rosacea, active acne, cold sores, or autoimmune conditions? [[Details]]
- Have you had any recent surgeries, chemical peels, laser treatments, microdermabrasion, or injections in the treatment area within the last 4-6 weeks? [[Yes / No - details and dates]]
- Do you have any metal implants, pacemakers, or electronic medical devices? [[Yes / No]]
- Do you have a history of fainting, seizures, or severe reactions to beauty services? [[Details]]
- Are you immunocompromised or taking medications that affect healing or immune response? [[Details]]
- Any other health information the provider should know for safe service? [[Details]]
4. Service-Specific Questions and History
For hair services (color, lightening, chemical straightening, extensions):
- Date of last color or chemical service: [[Date or N/A]]
- Previous reactions to hair color, bleach, relaxers, or perms? [[Yes / No - describe]]
- Current hair treatments (keratin, extensions, relaxer, etc.): [[Details]]
- Recent use of henna, box color, or metallic dyes? [[Yes / No]]
For skin / facial / peel / wax / lash / brow services:
- History of cold sores / herpes simplex? [[Yes / No]]
- Use of Accutane or isotretinoin in the past 6-12 months? [[Yes / No - end date]]
- Recent sun exposure, tanning beds, or self-tanner use? [[Details]]
- History of adverse reactions to wax, sugaring, or depilatories? [[Yes / No]]
- Contact lens wearer or recent eye procedures? (for lash/brow) [[Yes / No]]
- Any history of eye infections or sensitivity to adhesives? [[Details]]
For nail services:
- History of nail fungus, infections, or artificial nail reactions? [[Details]]
- Any acrylic, gel, or dip allergies? [[Yes / No]]
- Recent hand or foot injuries or surgeries? [[Details]]
5. Patch Test and Sensitivity Acknowledgment
For chemical services (color, lighteners, relaxers, adhesives, peels), a patch test is recommended 24-48 hours prior.
Patch Test Performed: [[Yes - Date/Time/Location on body / Declined by client]]
I understand that even with a negative patch test, allergic or sensitivity reactions can occur during or after service. I agree to notify the provider immediately of any itching, burning, swelling, or discomfort.
Client Initials: [[Initials]]
6. Informed Consent for Beauty Services
I, [[Client Full Legal Name]], voluntarily request and consent to the beauty and salon services described above to be performed by [[Provider / Stylist Name]] at [[Studio Name]].
I understand and acknowledge:
- The nature of the service(s), including the products, tools, and techniques to be used.
- The expected results and the possibility that results may vary based on my hair/skin/nail condition, previous treatments, aftercare compliance, and individual response.
- Potential risks and side effects, which may include but are not limited to: allergic reactions, chemical burns, hair breakage or loss, skin irritation or redness, swelling, infection, scarring, eye injury (for lash services), nail damage or separation, and in rare cases more serious reactions requiring medical attention.
- That the provider will take reasonable precautions but cannot guarantee specific outcomes or absence of adverse reactions.
- That I have disclosed all relevant health information and medications above. I understand that failure to disclose may increase risks.
- That I may withdraw consent at any time before or during the service.
- That the provider may stop or modify the service if any contraindication or adverse reaction is observed.
I have had the opportunity to ask questions and all my questions have been answered to my satisfaction. I am proceeding with the service of my own free will.
Client Signature: _______________________________ Date: [[Date]]
Printed Name: [[Client Full Legal Name]]
7. Minor Client Consent (if applicable)
If the client is under 18, parent or legal guardian must complete and sign.
Minor Client Name: [[Full Name]]
Age: [[Age]]
Parent/Guardian Name: [[Full Legal Name]]
Relationship: [[Mother / Father / Legal Guardian]]
Phone: [[Phone]]
I am the parent or legal guardian of the minor named above. I have read and understood the consultation, health screening, risks, and consent sections. I give full consent for the described services to be performed on the minor. I agree to ensure aftercare instructions are followed.
Parent/Guardian Signature: _______________________________ Date: [[Date]]
Provider Witness (if required): _______________________________
8. Photography, Video, and Media Consent / Release
I consent to the taking of photographs and/or video of the service process and results for the following purposes (check all that apply or initial):
- [[Initial]] Internal records only (before/after for my file)
- [[Initial]] Marketing and promotional use (website, social media, portfolio, ads) with no identifying information beyond the work
- [[Initial]] Educational / training use within the studio or professional community
- [[Initial]] Client may request copies for personal use
I understand that images may be cropped, edited for color, or used in composite materials. I release [[Studio Name]] and its staff from any claims related to the use of these images as described. I may revoke marketing consent in writing at any time for future uses.
Client Initials for Marketing Use: [[Initials or N/A]]
Client Signature: _______________________________ Date: [[Date]]
9. Cancellation, No-Show, and Studio Policies Acknowledgment
I have received, read, and agree to the studio's current policies:
- 24-hour (or [[Studio Policy Hours]]) cancellation notice is required for all appointments. Late cancellations or no-shows may be charged a fee of [[Fee Amount or % of service]] or forfeiture of deposit.
- Arrive on time. Late arrival may result in shortened service or rescheduling with fee.
- Payment is due at time of service unless a package or membership is used. Accepted methods: [[List: cash, card, etc.]]
- Gratuity is appreciated but never required.
- Products purchased are non-returnable for hygiene reasons once opened or used.
- I understand that results depend on my hair/skin condition, home care, and compliance with aftercare.
- I agree to provide honest feedback and to contact the studio promptly with any concerns within [[X days]] of service.
Client Initials: [[Initials]]
10. Aftercare Acknowledgment
I have received verbal and/or written aftercare instructions specific to the service(s) performed. I understand that proper aftercare is essential for safety, longevity of results, and to minimize complications. I agree to follow all instructions provided and to contact the studio immediately if I experience any concerning reaction.
Client Initials: [[Initials]]
11. Provider Notes and Observations (completed by provider)
Services Performed Today: [[Detailed list with products used, timing, batch/lot numbers if applicable]]
Observations / Patch Test Results: [[Notes]]
Recommendations / Home Care Products Suggested: [[List]]
Next Appointment: [[Date / Time / Service]]
Provider Signature / License #: _______________________________ Date: [[Date]]
12. Record Retention and Legal Notes
These forms become part of the client's permanent service record. Records are retained for a minimum of [[Number of Years, typically 3-7 depending on jurisdiction and service type]] years or as required by applicable state cosmetology board rules, health department regulations, or tax record requirements.
This packet is a professional template designed for beauty and salon use. It is not a substitute for legal advice. Studios should ensure forms comply with all applicable local, state, and federal laws (including data privacy, minor consent, and advertising rules). Consult qualified counsel for jurisdiction-specific requirements. Services involving medical claims or devices may trigger additional regulations.
Studio Use Only - Form Version: 2026-06 | Completed Forms Filed By: [[Staff Initials]]
This consultation and consent packet is provided as a professional sample template. It is not legal, medical, or regulatory advice. Verify all language and required elements against current state cosmetology board rules, health regulations, and local ordinances before use. Laws and best practices change. As of 2026-06.
Additional Guidance for Studio Staff
- Review all health screening answers before beginning any chemical or invasive service.
- Document any client refusals of patch testing or recommendations.
- Obtain fresh signatures for each major service day; do not rely on old forms for new services.
- For high-risk services (e.g., chemical peels, advanced lash, permanent cosmetics), consider separate specialized consent addenda.
- Maintain secure storage of completed forms (physical locked file or compliant digital system).
- Provide client a copy of signed forms upon request.
Numbered procedural reminder (staff):
- Greet client and provide blank packet or digital form.
- Allow private time for client to complete health and history sections.
- Review answers together; flag any contraindications and discuss with client.
- Perform and document patch test where indicated.
- Explain risks, benefits, and aftercare in plain language.
- Obtain all required initials and signatures before service begins.
- File completed packet immediately after service with provider notes.
- Schedule follow-up and note any product sales or recommendations.
This process supports safe, professional, client-centered service delivery and protects both parties.
Other Documents
Signed up front
Explained out loud
On brand
