Applies to all US salons and barbershops regardless of state
Customer Intake & Chemical Service Consent
Customer intake form and chemical service consent covering allergies, medical conditions, patch test documentation, and liability acknowledgment.
What this document covers
Before performing chemical services (hair color, bleach, relaxers, keratin treatments, perms, chemical peels, waxing), salons must assess client suitability and obtain informed consent. Many state cosmetology boards require documented patch tests for certain chemicals. This form protects both the client (from adverse reactions) and the salon (from liability claims). It covers medical history, allergy screening, previous chemical service history, and consent for specific treatments.
Key sections included
- Client contact and emergency information
- Medical history and allergy screening
- Medication disclosure (blood thinners, Accutane, etc.)
- Previous chemical service history
- Patch test documentation and results
- Chemical service consent and risks
- Pregnancy disclosure for chemical services
- Liability acknowledgment and signature
- Photo consent for portfolio/marketing
Frequently asked questions
Is a patch test legally required?
Many state boards require a 48-hour patch test before applying chemical hair color for new clients. Even where not legally mandated, it's a critical liability protection. Manufacturers almost universally recommend it.
Can I refuse service based on intake form answers?
Yes. If a client's medical history indicates risk (e.g., Accutane use within 6 months for chemical peels, or severe allergies to PPD in hair color), you should document your refusal and recommendation to consult their doctor.
Document details
- Legal basis
- State cosmetology regulations; FDA cosmetic safety requirements; Common law duty of care
- Enforced by
- State Boards of Cosmetology / FDA
- Penalty for absence
- Full liability for adverse reactions without documented consent. State board disciplinary action. Civil lawsuits for negligence (typical settlements $5,000-$100,000+).
- Category
- Operations
Document preview
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DocketPack — Generated Document
Customer Intake & Chemical Service Consent
Legal Reference
State cosmetology regulations; FDA cosmetic safety requirements; Common law duty of care. Enforced by State Boards of Cosmetology / FDA.
1. Client contact and emergency information
2. Medical history and allergy screening
3. Medication disclosure (blood thinners, Accutane, etc.)
4. Previous chemical service history
+ 5 more sections...
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