Name *

First Name

Last Name

Do you have or are you prone to any of the following? *

Select all that apply

ALLERGIES

TENDERNESS

REDNESS

SWELLING

IRRITATIONS

NONE

Have you had prior hair chemical services? *

Select all that apply

BLONDING (LIGHTER)

PERMANENT/DEMI/ SEMI HAIR COLOR

CHEMICAL RELAXER/PERM

KERATIN TREAMENTS

OTHER

NONE

DISCLAIMER : Please note chemicals including haircolor, perms, relaxers, keratin treatment and other chemicals, have certain side effects such as redness scabbing bruising scarring swelling tenderness and hyper pigmentation. *

YES, I UNDERSTAND

I have read the above information and I will address any and all concerns I have with my stylist prior to receiving services. I understand the risks of side effects and give my permission to CTL Artistry to perform the hair chemicals procedures we have discussed. *

YES, I GIVE PERMISSION.

I will hold CTL ARTISTRY harmless from any liability that may result from chemical procedures . I have given an accurate and honest account of the questions asked above including all allergies, prescription drugs and products I am currently ingesting or topically using. *

YES, I AGREE

I understand my stylist will take every precaution to minimize any reactions and I accept the possible risks. I am willing to follow recommendations for a home care regimen that can minimize possible negative reactions and result in the best outcome of my chemical service *

YES, I CONSENT & AGREE

I agree that this constitutes full disclosure, or written disclosures. I certify that I have read and fully understand the above information and I have been provided sufficient opportunity to discuss any questions or concerns. I understand the process and procedure of my service and except the risks. I do not hold CTL Artistry, the stylist or salon responsible for any of my conditions that were present but did not disclose at the time of this procedure which might be affected by the treatment performed today. *

YES, I CONSENT & AGREE