Customized Client Questionnaire
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
How did you hear about Cynthia Santana Hair Studio?
Website / Online Search
Yelp
Facebook
Referral
Other
If Referral, please list name
If Other, please let us know
Do you have a service provider request?
Your Hair Profile
What are your hair care goals?
What are your hair care challenges?
No Volume
Too thick
Dryness
Breakage
Frizziness
Won't stay curled
Dull
Curly hair & don't know what to do with it!
Other
What are you trying to achieve with your style?
Volume
Curl
Straight
Other
Average visits to a salon:
every 6 weeks
Every 6-12 weeks
Every 3-6 months
Once a year
What are your morning hair rituals?
How much styling time is spent at home?
Less than 15 min.
15-30 min.
30-45 min.
More than 45 min.
What is your home styling comfort level?
Uncomfortable
Comfortable
Very comfortable
I want some tips
What kind of styling tools are you using at home during your hair routine?
Flat Iron
Curling Iron
Blowdryer
Styling tool? Ain't nobody got time for that!
Other
Hair Versatility
Wear my hair the same everyday
Sometimes wear my hair differently on weekends
Open to new styles & change often
Try a new look everyday
Have you ever had a hair conditioning treatment service before?
Yes
No
What hair care products do you currently use?
What do you wish your hair did more of?
What is your beauty budget? List a price range you are comfortable with for your complete look,
Hair History
We have all done crazy things with our hair! Sometimes our daily routine will effect the outcome of your hair service. We just want to make sure your service will have the best results. So please be truthful and honest with the following questions. We don't judge.
Are you currently taking any prescriptions, vitamins, or hormones? If yes please list the items that may effect your service today.
No
Yes
Other
Have you ever experienced hair loss or scalp problems?
No
Yes
Other
Do you presently have any breakage, thinning or bald spots?
No
Yes
Not sure
What color or chemical services have you received within the past 2 years?
If you are looking for a color correction, please explain your previous experience and the changes you are expecting.
Please select any of the following chemical hair services you’ve received either professionally or at home.
Used box color (at home color remedy)
Please Select
Never
Less than 90 days ago
3-6 months ago
6-12 months ago
Have you ever received a chemical straighter or relaxer service or treatment?
Yes, within the last month
Yes, within the last 6-12 months
No
Please feel free to go into more detail about any questions you may have for your stylist
Upload front and back pictures of your current hairstyle
*
Upload some desired Hair results
*
What about your desired look do you like?
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the hair service being received.
*
Yes
Signature
*
Submit
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