Signed in as:
filler@godaddy.com
Please note hair coloring does have certain side effects such as redness, scabbing, bruising,
scarring, swelling, tenderness, hyperpigmentation.
I have read the above information and if I had any concerns I have addressed them with my
stylist. I give permission to perform the hair color procedure we have discussed and will hold
them harmless from any liability that may result from this treatment. I have given an accurate
account of the questions asked above including all known allergies or prescription drugs or
products I am currently ingesting or topically using. I understand my stylist will take every
precaution to minimize or eliminate negative reactions. I am willing to follow the
recommendations for a home care regimen that can minimize or eliminate possible negative
reactions. In the event that I may have additional questions or concerns regarding my
treatment or suggested home product/post-treatment care, I will consult my stylist immediately
I agree that this constitutes full disclosure, and that it supersedes any previous verbal or
written disclosures. I certify that I have read and fully understand the above information and
that I have had sufficient opportunity for discussion to have any questions answered. I
understand the procedure and accept the risks. I do not hold the salon or stylist, whose
signature appears below, responsible for any of my conditions that were present, but not
disclosed at the time of this procedure, which may be affected by the treatment performed
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