New Client Request Form

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Name
First Name
Last Name
2
Phone Number* This field is required.
Area Code
Phone Number
3
Email* This field is required.
example@example.com
4
Mailing Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
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Martinique
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Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
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Saint Helena
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Senegal
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Somaliland
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eSwatini
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Taiwan
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Tanzania
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Tonga
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Tunisia
Turkey
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Vatican City
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Isle of Man
US Virgin Islands
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Western Sahara
Yemen
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Zimbabwe
Other
Country
5
Birth month* This field is required.
6
Please add a front, side, back image of yourself in natural lighting. I recommend standing inside with an open window or door in front of you. Have another person take your photo with coming from behind them if possible
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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Which of these best describes your current situation
I am from the area and currently exploring my options
I am new to the area and searching for a new stylist
Looking for someone new however, I rarely visit the same stylist twice
I was referred to you by a current guest, looking for something new
8
How did you hear about me? (if referred by a current client please list their first and last name.)* This field is required.
9
How often do you wash your hair?* This field is required.
Daily
3-4 days+ days per week
1-2 days per week
10
I apply heat meaning: blowdryer, curling iron, curlers, flat iron, to my hair _______ times a week* This field is required.
11
Have you ever had a reaction to any salon chemicals?* This field is required.
12
Have you now or in the past used Henna Dye on your hair?* This field is required.
Yes
No
I'm not sure
13
My scalp is...* This field is required.
Oily
Dry and Flaky
Bald Spots Present
Noticeable Thinning
Scalp Abrasion/Irritation
Happy and Healthy
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My hairs appearance is.....* This field is required.
Frizzy
Coarse and Dry
Damaged
Silky Smooth
Healthy and Happy
Baby fine and easily damaged
Lacking Volume
15
If I let my hair air dry my hair is.....* This field is required.
Straight on it own
Barely wavy
Definitely Curly
Super Tight Curls
Kinky/Afro Texture
16
Often I am told by my stylst....* This field is required.
I have a ton of hair or really long hair and it takes additional time get my hair finished and dry
I have a medium amount of hair/length and usually don't require extra time
I have very little hair/short hair that is easy to dry
n/a
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What current products do you use to wash, condition, and style your hair? * This field is required.
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What type of future service(s) would you like to discuss?* This field is required.
Haircut
Curly Cut
Highlight/Lightening
All Over Color
Grey Coverage/Grey Blending
Balancing Uneven Color
Balayage
Vivid/Bright/Fashion Shade
Healthy Hair/Scalp
Hair Extensions
Head Spa Service
Blow Dry Style
Natural Curl Styling
Style Eduction
Virtual Style Coaching
Straightening
Wedding Hair
Braiding
19
Check all service(s) you have had done to your hair in the last 3 years. (Home or Professional)* This field is required.
Haircut
Color
Relaxer/Straightener
SmoothingTreatment /Brazilian
Highlight/Lightening Services
Permanent /Wave Services
None
20
Date of Your Last Cut or Color Service?
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My current hair color is* This field is required.
My natural hair color I have never colored my hair
Highlighted blonde
All over color w/ highlights
Colored light brown/dark blonde all over
Colored dark brown or black
Colored a natural red color
Colored Pink, Red, Blue, Green....
22
At my next color appointment I would like to.... (please select all that apply)
Blend my grey
Fully cover my grey
Transition to growing my grey out
Go lighter than my current hair color
Go Darker than my current hair color
Create a more dimensional or multi-tonal look
Balance uneven color
Go cooler/ashier
go warmer/richer
I want a complete transformation
I want to keep things the same
23
What concerns do you have about making this change?
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My desired maintenance schedule is* This field is required.
4-8 weeks
8-12 weeks
1-2 times a year
25
How much time can you commit to a single color session?
2-2.5 hours
3-3.5 hours
However long it take, I have no time limit
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What is most important to you?* This field is required.
Achieving my goal as quickly as possible
Maintaining the integrity and length of my hair
Keeping my service cost as low as possible
27
If you have an inspiration photo(s) please upload images here
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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What do you like about these images?
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Which days and times work best for you? Please select all boxes that apply.* This field is required.
Morning 9-11
Afternoon 12-4
Evening 5-7
I am not available on this day
I am flexible and can book any time
Wednesday
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Thursday
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Friday
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Saturday
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Wednesday
Thursday
Friday
Saturday
Morning 9-11
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Afternoon 12-4
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Evening 5-7
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I am not available on this day
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I am flexible and can book any time
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Morning 9-11
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Afternoon 12-4
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Evening 5-7
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I am not available on this day
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I am flexible and can book any time
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Morning 9-11
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Afternoon 12-4
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Evening 5-7
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I am not available on this day
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I am flexible and can book any time
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Morning 9-11
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Afternoon 12-4
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Evening 5-7
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I am not available on this day
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I am flexible and can book any time
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Please provide any other restrictions or informations about your availability here
31
Less than 48 hours notice to cancel or reschedule of any appointment will result in a $50 cancellation fee per services hour booked All fees must be paid before any future appointment can be made.* This field is required.
I understand
32
No call/No show/forgotten appointments will result in a fee of 100% of the missed service total.* This field is required.
I understand
33
Clients who miss/reschedule/cancel appointments repeatedly with less than 48 hours notice will be required to book with a credit card. A fee of 100% of the full-service total will occur for all missed/reschedule/canceled appointments indefinitely.* This field is required.
I understand
34
Any guest arriving more than 10 minutes late may be asked to reschedule or alter their service so as not to impact the timing of other scheduled appointments. Late arrivals resulting in a cancellation of reserved appointment/service will be treated as a last-minute cancellation and appropriate fees will apply.* This field is required.
I understand
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I am happy to make minor adjustments that align with our original consultation within 7 days of the original service. Adjustments that alter the original plan or are requested after 7 days of the original service will require full payment. I do not provide refunds on services.* This field is required.
I understand
36
I ask that all children be supervised and only present when being provided a service. Please arrange separate supervision for children during your service time. The environment of a salon is meant to be a getaway from the stresses of daily life. In order for it to stay that way, children should be left home.* This field is required.
I understand
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I consent to the use of my image* This field is required.
Yes
No
38
I would like to tag you please leave your Instagram/Facebook handle below
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Sign here
Clear
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Booking Your Future AppointmentNext book your appointment. Please select all service you are requesting with my name in the providers field before hitting search. (If you wear your hair naturally curly select the specialized curly cut option or natural curly style option as your finish service)
I understand
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