Laser Hair Removal Informed Consent

KLEY Hair Salon & Spa – Client Intake Form

KLEY HAIR SALON & SPA

CLIENT INTAKE, CONSENT & LIABILITY AGREEMENT

Client Information

Full Name

Date of Birth

Age

Phone Number

Email Address

Address

Emergency Contact Name

Emergency Contact Phone

How Did You Hear About Us?

Google Search

Google Maps

Instagram

TikTok

Facebook

Yelp

Website

Walk-in

Returning Client

Friend / Family Referral (Name) Other

Services Requested

Other

Date of last chemical service (if any)

Medical & Allergy Disclosure

Allergies or sensitivities

Scalp condition

Hair loss or thinning

Pregnancy

Hormonal condition

Medications or supplements

If yes, please explain

Informed Consent, Liability & Agreement

I confirm that all information provided is complete and accurate. I voluntarily request and consent to receive hair and/or spa services from Kley Hair Salon & Spa. I understand these services may involve chemicals, heat, tools, and techniques that may cause irritation, allergic reactions, discomfort, or results different from my expectations.

I knowingly assume all risks associated with hair and spa services, including hair damage, color variation, scalp irritation, burns, dryness, thinning, hair loss, or allergic reactions, even if caused by ordinary negligence, to the fullest extent permitted by Texas law.

I release and hold harmless Kley Hair Salon & Spa, its owners, employees, and affiliates from any claims, damages, or legal actions related to services performed.

I understand all services are final. No refunds, disputes, or chargebacks will be accepted.

Photo & Video Consent (Optional)

YES

Electronic Signature

Client Signature

Date