Chemical Waiver & Questionnaire Form

Chemical Service Consent & Waiver

Chemical services are designed to alter the current state, appearance, color, texture, and/or structure of the hair. Because chemical services create changes within the hair strand, I understand that my hair may respond differently based on its current condition, previous chemical services, product use, and at-home maintenance.

By signing below, I acknowledge and agree to the following:

Chemical Service Consent

I voluntarily consent to receiving the chemical service discussed during my consultation. I understand that chemical processing may permanently or temporarily alter the original structure, texture, color, condition, or overall appearance of my hair.

I understand that results may vary depending on my hair's current condition, density, porosity, previous chemical treatments, product use, and chemical history. While reasonable precautions will be taken to protect the integrity of my hair, specific results cannot be guaranteed.

Allergies & Sensitivities

I agree to inform my stylist of any known allergies, sensitivities, previous reactions, or other concerns related to ingredients or chemicals commonly found in professional hair and beauty products.

I understand that a patch/allergy test may be performed prior to my chemical service when appropriate. A patch test can help identify potential sensitivities but does not guarantee that an allergic or adverse reaction will not occur during or after the full service.

When a patch test is recommended or requested, it should be completed approximately 72 hours before the scheduled chemical service.

Reactions & Irritation

I understand that irritation, sensitivity, itching, redness, burning, swelling, or another unexpected reaction may occur during or following a chemical service.

I agree to immediately notify my stylist of any discomfort experienced during the service.

If irritation or another reaction develops within 24–72 hours following my appointment, I agree to notify Humbly Touched as soon as possible so that appropriate next-step guidance regarding the hair or service can be provided.

I understand that Humbly Touched does not provide medical diagnosis or treatment. If symptoms are severe, rapidly worsening, or I believe I am experiencing a medical emergency, I understand that I should seek appropriate medical attention immediately.

Professional Maintenance & At-Home Care

I understand that chemically treated hair requires proper maintenance to help preserve the integrity, appearance, and overall condition of the hair.

I understand that failure to follow recommended professional maintenance and at-home care may contribute to dryness, breakage, shedding, color changes, loss of elasticity, or additional damage.

I accept responsibility for following the aftercare recommendations provided by my stylist, properly maintaining my hair between appointments, and scheduling routine professional maintenance as recommended.

Client Disclosure

I agree to provide my stylist with complete and accurate information regarding previous chemical services and treatments performed professionally or at home.

I understand that withholding or providing incomplete information regarding my hair's chemical history may affect the outcome of my service and increase the possibility of an unexpected result or damage.

Acknowledgment & Consent

By submitting this form, I confirm that the information I have provided is complete and accurate to the best of my knowledge.

I confirm that I have read and understand the information contained in this Chemical Service Consent & Waiver. I have had the opportunity to ask questions regarding my service and understand the potential risks, maintenance requirements, and aftercare associated with chemically treated hair.

I voluntarily authorize my stylist at Humbly Touched to perform the chemical service discussed during my consultation.