Name * First Name Last Name Email * Phone * (###) ### #### Have you ever had hair extensions? * Do you have any known skin or scalp allergies? * Do you have now, or have had in the past, probelms with hair loss? * Are you willing to use the recommended products and follow hair care gudiance? * Yes No Please select any of the following that might apply to you: * Eating Disorders or Poor Nutrition Chemotherapy Thyroid Disease Recent Childbirth (120 days) Extreme Stress Hormonal Imbalance None of the above Other concerns you may have prior to installing? Please read the following statements and check the box next to them. Your checks confirm you have read, agree to, and understand this information. * I agree to have hair extensions applied to my natural hair and/or removed and retouched. I understand that there are risks associated with having hair extensions applied to or removed from my natural hair. I further understand that as a part of the procedure, irritation, itching, headaches or damage to my natural hair may occur. I understand and agree to the after-care instructions provided. I realize and accept the consequences of faliure to adhere to these instructions, as it may cause the hair extensions to fall out prematuerely, cause hair damage, and/or decrease the time the extensions will last. These after-care directions include: Do not use shampoos that contain sulf (such as dandruff shampoo). Always shampoo with your head up, starting with your scalp and working your way through the ends. Keep conditioners away from the braided areas and always rinse conditioners thoroughly. Brush your hair daily with recommended brush. Pull hair back in a loose braid or ponytail with sleeping or "windy" conditions. I understand that nautal hair sheds an average 50-100 hairs daily and will notice the loose strands that will be combed out from briads during retouch services. This agreement will remain in effect for this procedure and all future procedures. I understand this agreement is legal and binding. I am over 18 years of age and consent to the agreement and treatment. I release THE MONET HOUSE from all liability associated with this procedure, which is performed with the utmost attention to safety and proper application, using tools and products that Melissa has been properly trained to use. By checking this box, I verify that I have read and understand the above statements and agree to them. Date * MM DD YYYY Cancellation Fees * Please cancel or reschedule your service appointment 48 hours in advance. Day of cancellations will be charged full price. 24 hour cancellations will be charged 25% of full price. No show, no call, no more services for you. I understand that full payment of hair is requried pior to booking your install appointment. * Yes I undestand that there are no refunds on services and hair purchaces. * Yes Thank you! Hair Extension Agreement
