Client Concern Report

1. Client Details

1.1 Full Name *

1.2 Email Address *

1.3 Contact Number

1.4 Booking Method *

2. Treatment Information

2.1 Treatment Date *

2.2 Date Issue First Noticed *

2.3 Service(s) Received *

2.4 Other Service(s)

2.5 Treatment(s) You Are Concerned About *

2.6 Therapist Name (if known)

3. Type of Concern

3.1 Type of Concern *

3.2 Specify Other Type of Concern

4. Evidence & Description

4.1 Upload Photos / Evidence

4.2 Describe What Happened *

5. Contact & Assessment

5.1 Visited salon after treatment? *

5.2 Informed the salon? *

5.3 Date Reported

5.4 Can attend in-person assessment? *

5.5 Reason for not attending

5.6 Preferred Assessment Date

5.7 Preferred Assessment Time

6. Patch Test, Aftercare & Disclaimer

6.1 Patch test completed (where required)? *

6.2 Aftercare instructions signed? *

6.3 Disclaimer signed (where required)? *

7. Health Impact & Management

7.1 Impact caused *

7.2 Steps taken to manage

10. Declaration & Signature

Digital Signature *

I confirm that the information provided is truthful, accurate, and not misleading. I understand that submitting false, exaggerated, or malicious information may result in immediate rejection of my complaint, refusal of future services, permanent exclusion from the salon, and escalation for further Investigation. I acknowledge that false allegations may constitute harassment & abuse of process and may be addressed accordingly under applicable laws. I authorize Seema’s Beauty Salon to investigate this matter using all relevant records, documentation, and lawful verification methods.