Consent Form for Botox Hair Treatment & Permanent Hair Straightening

Client Information

Name:

Date of Birth:

Phone:

Email:

Emergency Contact:

Medical History

Please provide any relevant information regarding your medical history or conditions that may affect the treatment (e.g., skin allergies, scalp conditions, chronic illnesses).

Botox Hair Treatment
Permanent Hair Straightening

I, the undersigned, hereby consent to the following procedures:

BOTOX HAIR TREATMENT:

I understand that Botox for hair is a non-invasive treatment designed to smooth and hydrate the hair, improving its appearance and texture. I acknowledge that results may vary, and I have been informed of the potential risks, including but not limited to scalp irritation, allergic reac- tions, or hair breakage.

PERMANENT HAIR STRAIGHTENING:

I consent to the use of chemical products to permanently straighten my hair. I understand that the treatment involves chemicals that may cause scalp irritation or allergic reactions. I am aware that there may be a need for touch-up treatments, and that results may vary depending on my hair type.

RISKS AND SIDE EFFECTS :

I acknowledge that both treatments may have certain risks, including but not limited to irritation, allergic reactions, hairdamage, or changes in hair texture.

AFTERCARE INSTRUCTIONS :

I agree to follow the aftercare instructions provided by my technician to ensure optimal results and minimize anyadverse effects.

ACKNOWLEDGEMENT AND RELEASE OF LIABILITY :

I understand the nature of the treatments, including any risks involved, and consent to undergoing these procedures. Irelease the provider from any liability or claim arising from these treatments, including any potential side effects.

Client Signature :

Date :

Therapist Signature :

Therapist Name :

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Consent Form for Botox Hair Treatment & Permanent Hair Straightening