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Chemical Hair Form Customer Name: ______________________________ Date: ____________________________ When was your die hard chemical serving? ________________________________________ What type of service did you receive? (color, highlight, relaxer, perm, etc.) _______________________________________________________________________ take over you applied any at home chemicals? (color, perms, straighteners, or lighteners such as sun in?) __________ If yes, what kind? ____________________________________ Do you pitch any allergies: _______________________________________________________________________ Have you ever had any kind of chemical reaction to any chemical treatment or hair fruit? _____ If yes, explain ____________________________________________________________ What hair products do you currently use? ________________________________________________________________________ _______________________________________________________________________ Do you have any hair concerns or questions that you would like your styler to address?

_______________________________________________________________________ _______________________________________________________________________ I am advised that YOUphoria Day wellness club & Salon result re-do, change, or modify my chemical service within two weeks of my appointment if I am non satisfied for any reason. However, if I do not apprise the hairstylist or management within two weeks I will be charged regular price to re-do or change any chemical service. I am aware of YOUphoria Day Spa & Salons cancelation policy and will abide by the guidelines set therein. I do hereby state that the above information is true and complete to the trump out of my knowledge. I also understand that failure to notify the stylist of any previous chemicals or products applied to my hair or any health concerns may result in insurance including but not limited to hair breakage, loss of hair, botheration or burns to my skin and/or scalp, and/or aggravations to health issues. I hold... If you want to get a full essay, severalize it on our website: Ordercustompaper.com

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