Perm, Relaxer & Keratin Treatment Consent Form
This consent form is required before any texture-altering chemical service — perming, chemical relaxing, or keratin / smoothing treatment. These services use strong reducing agents, hydroxides, or aldehyde-based smoothers that can permanently change the structure of your hair. Please read and complete every section carefully.
Section 1 — Client & Appointment
Appointment date: Appointment time:
Stylist / technician performing the service:
Section 2 — Service Requested
Select the specific service you are receiving today:
Product / brand being used (filled by stylist):
Desired result (e.g. loose waves, bone-straight, softer curl pattern):
Section 3 — Strand Test & Chemical History
A strand test is strongly recommended when combining chemical services or when hair has been previously processed. Mixing incompatible chemicals (e.g. hydroxide relaxer over a thioglycolate perm) can cause severe breakage.
Have you had any of the following chemical services in the last 12 months? Select all that apply:
Date of most recent chemical service (if known):
Strand test performed today?
Section 4 — Health & Safety Disclosure
Certain conditions can affect both the safety and the outcome of chemical services. Please tick everything that applies:
Any additional medical or hair-condition notes:
Section 5 — Risks Acknowledgement
Please tick each statement to confirm you have read and understood it:
Section 6 — Aftercare Window
First permitted wash date (filled by stylist):
Recommended at-home products:
If you have any concerns within the first 7 days after your service — such as unusual scalp irritation, excessive breakage, or your hair feeling "gummy" when wet — please contact the salon immediately so we can help.
Authorized representative — printed name:
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