Health Declaration & Waiver / Photo consent Form

First Name

Last Name

Cell Phone

Any known allergies/medical conditions

I understand that I have a risk of contracting virus during the service. I agree to obey the rules of the salon during my appointment to minimize the spread of viruses. I agree to not visit the salon for any of the services provided if I have symptoms of COVID-19 or possibility of having any other contagious illnesses.

I have reviewed and aware of the risk of receiving chemical services. I understand that a patch test is recommended, and by avoiding a testing, I waive my right to hold Yuki and THE SALON LEPETIE to be responsible for all adverse health reactions from this service, or for any undesired results of the treatment.View Risks

*If you would like to request for a patch test, please contact Yuki to schedule for a testing. A test must be performed 24-48hrs prior to the appointment. The service cannot be performed on the same day.

I understand that before & after photos are required at the first visit at THE SALON LEPETIE for insurance purposes.

*Your photos will remain private and will not be shared without your consent. If you agree to allow your photos to be used on THE SALON LEPETIE's Instagram and Google platforms, you'll earn 20 loyalty rewards when your photos are used.

I acknowledge that the information I have given in this form is accurate and complete. By signing below, I confirm that I understand and agree to all terms and statements in this form.

By typing your name below, you are signing this form electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this form.

Date