Client Information

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Health Questionnaire

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Hair and Scalp Condition

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Acknowledgment and Consent:

I confirm that I have provided accurate and complete information regarding my medical history, hair history, and scalp condition.

I understand that chemical hair straightening treatments (including but not limited to keratin, Brazilian, Japanese, or relaxer treatments) involve the use of strong chemical agents to alter the natural structure of the hair.
I acknowledge the potential risks and side effects, which may include but are not limited to:

• Scalp irritation, sensitivity, burns, or redness
• Temporary or permanent hair breakage, dryness, or thinning
• Alterations to hair color or texture
• Allergic reactions to ingredients
• The possibility that results may vary depending on hair type, hair condition, previous treatments, and home care practices

I understand that proper at-home maintenance, including the use of sulfate-free shampoos and professional hair care products, is necessary to maintain the results and health of my hair after treatment.

I release Unique Styles Hair and Esthetics, its staff, and affiliates from any liability associated with this procedure, understanding that all reasonable precautions will be taken for my safety and the best outcome.

I voluntarily consent to proceed with the hair straightening service at Unique Styles Hair and Esthetics.

Post-Treatment Care Instructions:

• Avoid washing the hair for at least 48–72 hours post-treatment (depending on the product used).
• Refrain from tying, pinning, or tucking the hair behind the ears during the initial post-treatment period.
• Use only sulfate-free, paraben-free shampoos and conditioners recommended by your stylist.
• Limit exposure to chlorinated or salt water.
• Minimize the use of heated styling tools to prevent damage.