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HOME
SERVICES
STYLISTS
ABOUT JAMAL
CAREERS
CAREERS
Apprenticeship Program
JE EDUCATION
CONTACT
Make AN Appointment
Guest Profile
Name
*
First Name
Last Name
Age
*
Today's Date
*
MM
DD
YYYY
Contact Phone
*
(###)
###
####
Occupation
*
Email Address
*
I Am Currently:
*
Pregnant
Menopausal
Using Oral Contraception
Taking Hormone Supplements
N/A
Have You Had A Hysterectomy?
*
Yes
No
Do You Have Children?
*
Yes
No
If Yes, What Age?
Do You Suffer From Any Allergies?
*
Yes
No
Please Explain:
Date Of Your Last Shampoo:
MM
DD
YYYY
Is Your Hair Currently Relaxed Or Natural?
*
Relaxed
Natural
Please List All The Products You Currently Use On Your Hair:
*
Do You Relax Your Hair?
*
Yes
No
Date Of Your Last Relaxer:
MM
DD
YYYY
Have You Ever Received Any Of These Color Treatments?:
*
Rinse
Semi
Demi
Henna
Permanent
Bleach
N/A
Date Of Your Last Color Treatment:
MM
DD
YYYY
Has A Medical Professional Prescribed Th Use Of Any Shampoos, Scalp Creams, Etc.?
*
Yes
No
Please Explain:
List Any Areas Of Hair Loss, Breakage, Thinning:
Image Of Your Hair
FileField;MaxSize=1000;Multiple;addText=Add_your_Image;
How Often Do You Use Flat Irons, Curling Irons, Or Other Hot Appliances On Your Hair?
*
What Do You Do To Your Hair Before Going To Bed?
*
What Do You Do To Your Hair When You Wake Up?
*
In The Last 12 Months, Did You:
*
Regularly take vitamins/nutritional supplements
Wear hair extensions or wig
Wear sisterlocks/dreadlocks
Dieting and/or signficant weight loss/gain
Receive hair transplant or fusion
Wear cornrows/braids
Have surgery or major accident
Go to a Dominican Salon
N/A
If you have gone to a Dominican Salon, when was your last visit?
How Did You Hear About Us?
*
Terms
*
In exchange for participation in the following hair services: SHAMPOO, CONDITIONING, DRYING, CUTTING, COLORING, BRAIDING, RELAXING, CHEMICAL TREATMENTS, WEAVING, AND/OR STYLING organized and executed by JAMAL EDMONDS/JE PARLOUR 5623 Allentown Road, Suite #202, Suitland, MD, I agree for myself and (if applicable) for the members of my family, to the following: 1. I understand the entire process and the services to be executed which were explained to myself and (if applicable) to my family members by JAMAL EDMONDS/JE PARLOUR during my consultation. 2. I recognize that there are certain inherent risks including but not limited to RASHES, SWELLING, SORES, LESIONS, AND/OR BREAKAGE, associated with the above described services and I assume full responsibility for personal injury to myself and (if applicable) my family members, and further release and discharge JAMAL EDMONDS/JE PARLOUR for injury, loss or damage arising out of my or my family's participation. 3. I understand that I and (if applicable) my family members may be going against the professional advice given by JAMAL EDMONDS/JE PARLOUR, or the employees, representatives or agents of JAMAL EDMONDS/JE PARLOUR, and agree for myself and (if applicable) my family members to proceed with services requested by myself and (if applicable) my family members. 4. I agree to observe and obey all posted rules and warnings, and further agree to follow any oral instructions or directions given by JAMAL EDMONDS/JE PARLOUR, or the employees, representatives or agents of JAMAL EDMONDS/JE PARLOUR. 5. I agree to indemnify and defend JJAMAL EDMONDS/JE PARLOUR against all claims, causes of action, damages, judgments, costs or expenses, including attorney fees and other litigation costs, which may in any way arise from my or my family's use of or presence upon the facilities of JAMAL EDMONDS/JE PARLOUR. 6. I agree to pay for all damages to the supplies and facilities of JAMAL EDMONDS/JE PARLOUR caused by my or my family's negligent, reckless, or willful actions. 7. Any legal or equitable claim that may arise from participation in the above shall be resolved under Maryland law.
By checking this circle I acknowledge and agree with the terms and conditions above.
If Parent Of Minor, Please Type Your Name
Thank you!
