SALON CLIENT CONSULTATION CARD

Client Information Full Name: _________________________________________________ Address: ___________________________________________________ Phone: ___________________ Email: _________________________ Date of Birth: //______ Emergency Contact: _______________________ Phone: _____________

Medical History & Safety Check Please answer all questions honestly. Your safety is our priority.

1. Do you suffer from high or low blood pressure? [ ] Yes [ ] No
2. Do you have epilepsy, diabetes, or heart conditions? [ ] Yes [ ] No
3. Do you have a pacemaker or metal implants? [ ] Yes [ ] No
4. Are you pregnant or breastfeeding? [ ] Yes [ ] No
5. Do you wear contact lenses? [ ] Yes [ ] No

Allergies & Sensitivities Please list any known allergies to foods, medications, or products (e.g. ammonia, peroxide, latex, plants).

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Skin & Hair History Have you had any of the following in the last 6 months?

• Surgery? [ ] Yes [ ] No
• Skin treatments (peels, microdermabrasion, laser)? [ ] Yes [ ] No
• New medication (including Accutane/Roaccutane)? [ ] Yes [ ] No
• Hair colouring, perming, or relaxing (at home or salon)? [ ] Yes [ ] No

Consultation Notes Current Condition of Hair/Skin: __________________________________ Client Request / Desired Outcome: ________________________________ Professional Recommendation: ____________________________________ Service Agreed: ________________________________________________ Product / Formula Used:

• Product: _________________ Shade: _________________
• Developer: _________________ %
• Timing: _________________ minutes

Financial & Privacy Consent Total Cost Estimate: $ _________________ Deposit Required: $ _________________

I consent to the collection of my personal information for the purpose of beauty/hair services. I understand my information will be stored securely. Client Signature: _______________________ Date: //____

I consent to receive promotional emails and SMS from this business. [ ] Yes [ ] No

Service Provider Details Staff Name: _______________________ Signature: _________________ Date of Next Appointment: //____