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ZEN HEAD CLIENT CONSENT FORM AND WAIVER

I am over the age of 18 and give my permission to Zen Head to perform a head spa treatment. I understand that this treatment is not a substitute for traditional medical treatment or medications, and that it is not a medical procedure to cure eczema, psoriasis, or any skin disease.


I understand that the service provider does not diagnose illnesses or injuries, nor does the service provider prescribe medications. I understand that this treatment is for relaxation only. 


I acknowledge that if I have any medical conditions, pregnancy, allergies, medications (oral or topical) that may be affected by the treatment or services requested, I have the opportunity to discuss such conditions with the service provider. I also have clearance from my physician to receive this treatment.


I understand that the risks associated with this treatment include, but are not limited to:

  • Superficial bruising
  • Short-term muscle soreness
  • Exacerbation of undiscovered injury

I therefore release the company and the individual service provider from all liability concerning these injuries that may occur during the massage session.


The company and the service provider are not responsible for any allergic reaction I experience.


I understand the importance of informing my service provider of all medical conditions and medications I am taking, and I will let the service provider know about any changes to these. I understand that there may be additional risks based on my physical condition.


I understand that it is my responsibility to inform my service provider of any discomfort I may feel during the session so he/she may adjust accordingly.


I understand that I or the service provider may terminate the session at any time.


I have been given a chance to ask questions about the session and my questions have been answered.


I agree to the fees discussed and fully understand that a cancellation fee of 50% of the price of the treatment will be charged or deducted off the deposit in the event of cancellation of treatment with less than 24-hour notice. Lateness up to 15 minutes will be deducted from your scheduled appointment time. After 15 minutes, you will be considered a no-show and will be charged according to our cancellation policy (50% of service). The entire staff is dedicated to client satisfaction, and Zen Head will send an appointment reminder prior to your scheduled service. Zen Head employs a no-refund policy, and I am aware of this. 


I certify that I have read and initialed the above paragraphs and have had explained to me fully and understand the above consent and procedure permit and that the explanations therein referred to were made. I accept full responsibility for these and/or any other complications which may arise or result during or following the treatment(s) which is to be performed at my request according to this consent. 

Zen Head Spa Policies

Clients should arrive to appointment free of make-up and jewelry.

All retail and gift card sales are final.

All services are final once completed, and no refunds will be issued.

Guests, including children, are not permitted during your appointment, with the exception of parent/guardian remaining present during head spa for minors under age 16.

I understand that a head spa treatment cannot be performed on clients with extensions, braids, or styles that obstruct access to the scalp, or on clients with open wounds, sores, or severely inflamed scalp disorders. Your service provider may determine during analysis that a head spa treatment cannot be performed. I also understand that I should wait at least 1 week before and after a chemical service of any kind.

Clients under age 18 must complete parental/guardian consent waiver.

Clients under age 16 must have a parent/guardian present during their appointment.


Today's Date: May 10, 2025

First Client Name

First Name*

Last Name*

Phone*
First Client Date of Birth*
First Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
First Client Signature*
Second Client Name

First Name*

Last Name*

Phone*
Second Client Date of Birth*
Second Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Third Client Name

First Name*

Last Name*

Phone*
Third Client Date of Birth*
Third Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Fourth Client Name

First Name*

Last Name*

Phone*
Fourth Client Date of Birth*
Fourth Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Fifth Client Name

First Name*

Last Name*

Phone*
Fifth Client Date of Birth*
Fifth Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Sixth Client Name

First Name*

Last Name*

Phone*
Sixth Client Date of Birth*
Sixth Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Seventh Client Name

First Name*

Last Name*

Phone*
Seventh Client Date of Birth*
Seventh Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Eighth Client Name

First Name*

Last Name*

Phone*
Eighth Client Date of Birth*
Eighth Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Ninth Client Name

First Name*

Last Name*

Phone*
Ninth Client Date of Birth*
Ninth Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Tenth Client Name

First Name*

Last Name*

Phone*
Tenth Client Date of Birth*
Tenth Client Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Parent or Guardian's Email Address

Email*

Confirm Email*
Check to receive information, news, and discounts by e-mail.
Parent(s) or court-appointed legal guardian(s) must sign for any participating minor (those under 18 years of age) and agree that they and the minor are subject to all the terms of this document, as set forth above.


By signing below the parent or court-appointed legal guardian agrees that they are also subject to all the terms of this document, as set forth above.
Parent or Guardian's Name

First Name*

Last Name*

Phone*
Parent or Guardian's Date of Birth*
Parent or Guardian's Intake Form
Are you currently pregnant?*
No
Yes
Have you had a head spa treatment before?*
No
Yes
Have you ever had any issues with aromatherapy essential oils?*
No
Yes
Do you have any allergies or sensitivities?*
No
Yes

If you answered yes to any question, please elaborate.
Do you have any known scalp conditions, skin infections, diseases, viruses, or recent injuries/surgeries?*
No
Yes

If so, please describe:

What are your goals for your head spa session?
Please describe your hair (check all that apply):*
Curly
Straight
Oily
Dry
Color treated (Zen Head is not responsible for changes in color due to the service)

How did you hear about us?
I hereby grant permission to Zen Head to use photographs or video of me taken during my head spa session on social media, on our website, or in advertisements.*
Yes, I Agree
No, I Do Not Agree
Parent or Guardian's Signature*
Electronic Signature Consent*
 By checking here, you are consenting to the use of your electronic signature in lieu of an original signature on paper. You have the right to request that you sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged for such copy and no special hardware or software is required to view it. Your agreement to use an electronic signature with us for any documents will continue until such time as you notify us in writing that you no longer wish to use an electronic signature. There is no penalty for withdrawing your consent. You should always make sure that we have a current email address in order to contact you regarding any changes, if necessary.


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