Hair Color Service Consent Form

This consent form must be completed before any chemical colour service. Please read each section carefully and answer honestly — this helps us protect your hair health and achieve the best possible outcome.

Section 1 — Client Information

Full name:

Appointment date:

Stylist name:

Section 2 — Service Requested

Which colour service are you receiving today? Select all that apply:

Full colour / root retouch

Highlights / foils

Balayage / ombre

Bleach / lightening

Toner / gloss

Fashion / vivid colour

Target colour / result description:

Section 3 — Allergy Patch Test

A patch test is recommended 48 hours before any colour service containing PPD or similar sensitisers.

Have you had an allergy patch test performed in the past 6 months?

Yes — no reaction observed

Yes — a reaction was observed (please describe below)

No — I have not had a patch test

Patch test date (if applicable):

If a reaction was observed, please describe it:

Have you ever had an allergic reaction to hair dye or chemical products in the past?

Yes

No

I'm not sure

Section 4 — Hair & Health Disclosure

Please disclose any of the following that apply to you:

Previously used box dye / at-home colour

Currently on medication (e.g. chemotherapy, hormones, antibiotics)

Pregnant or breastfeeding

Scalp condition (e.g. psoriasis, eczema, open wounds)

Hair extensions, weave, or bonds currently in hair

Any additional health information relevant to this service:

Section 5 — Consent & Agreement

By submitting this form, I confirm and agree to the following:

1. I understand that chemical colour services carry inherent risks including, but not limited to, scalp irritation, allergic reaction, or unexpected colour results, especially on previously treated or damaged hair.
2. I have disclosed all relevant hair history and health information to the best of my knowledge. I understand that withholding information may affect the outcome of the service.
3. I understand that significant colour changes (e.g. going from dark to light) may require multiple sessions, and that the stylist will advise on what is safely achievable in one appointment.
4. I agree to follow the aftercare advice provided by my stylist to maintain the health of my hair following this service.
5. The salon and stylist are not liable for damage resulting from undisclosed information or failure to follow aftercare instructions.

I have read, understood, and agree to the above statements:

Yes, I agree

Thank you for completing this consent form. Your stylist will review it with you before the service begins. Please feel free to ask any questions at any time.