Client Consultation Form

Please note this form must be kept for a minimum of 7 years for insurance purposes (all sections need to be completed)

First Name

Last Name

Phone

Birthday

Select an Address

Here at The Beauty Hut Heighington, we take your privacy seriously and will only use your personal information to administer your profile and to provide the services you have requested from us. In order to provide you with our services we will need to collect some personal information. We will use this information for The Beauty Hut to provide the services you have requested.

I consent to the collection and use of my personal information with regards to my treatments.

We need your permission to contact you with regards to appointment bookings, confirmation & reminders, information regarding your appointments, special offers & aftercare etc. We will not send any information or correspondence that is not regarding your appointments with The Beauty Hut Heighington.

I consent to The Beauty Hut Heighington contacting me via email, phone, text message, apps, post or social media.

Some treatments require us to take a before & after photo i.e eyebrow definition, henna brows etc. We will always inform you before taking any pictures. Sometimes we like to show others your transformations and use them for advertising & marketing, if you consent to your picture taken and/or for use by The Beauty Hut Heighington please choose an option below.

I consent to The Beauty Hut Heighington taking my picture for treatment purposes only I consent to The Beauty Hut Heighington taking my picture for treatment purposes and use for advertising & marketing.

How did you hear about The Beauty Hut Heighington Salon?

Website / Online Search

FaceBook

Referral

Other

If Other, please let us know

If Referral, please list name

Your Beauty Profile

Medical Information

We need to gather this information for safety purposes and to evaluate if you are suitable for your requested treatments.

Do you suffer from any of the listed conditions. If any are marked yes, please go into more detail in the space provided.

Have you received two COVID jabs?

Yes

Have you received a COVID booster jab?

Yes

Are you pregnant? (There may be some treatment that are not suitable during pregnancy or at particular stages of pregnancy)

Are you pregnant?

Yes

If yes please state due date

Have you ever had an adverse reaction to any treatments in the past?

Yes

ONLY FILL OUT IF PATCH TEST IS REQUIRED

Skin Testing

It is recommended that if you have tested positive with COVID since your last hair colouring application you have another skin test at least 24hrs prior to any colouring services. This is due to a possible risk of developing allergies after catching the virus.

If you are a new client or have not had a colour with us in the last 6 months, you must have a skin test a least 24hrs prior to any beauty tinting or hair colouring services, before we can carry out any on scalp/skin tinting services .

Yes. A patch test is required

Patch test for following treatment(s)

Eyebrow/Eyelash Tint

Brow lamination

Lash lift

Henna

THANK YOU FOR TAKING THE TIME TO FILL IN YOUR CONSULTATION FORM THIS WILL ENABLE US TO PROVIDE YOU WITH THE BEST TREATMENT AND EXPERIENCE POSSIBLE. IF YOU ARE UNSURE ABOUT ANYTHING CONCERNING YOUR CHOSEN TREATMENT, PLEASE CONTACT THE BEAUTY HUT HEIGHINGTON.

I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the service being received. I declare that the above information I have given concerning my health is correct