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Consultation Form

Before your Japanese Head Spa treatment, we ask that all clients complete a short consultation form. This allows us to understand your medical history, scalp condition, and any factors that may affect your treatment. The information you provide helps us ensure your experience is both safe and tailored to your individual needs.

Please complete the form below prior to your appointment. All information provided will be kept confidential and used solely for the purpose of your Japanese Head Spa treatment at Hair and Harmony.

Birthday
Day
Month
Year
Are you currently taking any medication?
Yes
No
Do you have any allergies or sensitivities (including skin or scalp)?
Yes
No
Do you have any problems walking up and down stairs?
Yes
No
Do you currently have hair extensions fitted?
Yes
No
Have you had any surgery in the past 6 months?
Yes
No
Please tick all that apply
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Signature

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