Style Queen Beauty New Client Consultation Form
Full Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
-
Area Code
Phone Number
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact
*
First Name
Last Name
Emergency Contact Phone Number
*
-
Area Code
Phone Number
Emergency Contact Relationship
*
Your Date of Birth
*
-
Month
-
Day
Year
Date
Marital Status
*
Single
Married
Divorced
Other
Current Occupation
*
Instagram Handle
*
www.instagram.com/yournamehere
Where did you hear about this salon?
*
Instagram
Twitter
Facebook
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Other
Please upload a photo of your current hair
*
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Please upload a photo of yourself
*
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How would you describe yourself and your personality?
*
What level of communication would you like from your stylist?
*
Silent appointment
Education throughout appointment
Client will direct conversation
Stylist will direct conversation
Are you tender headed?
*
Yes
No
Where would you like your part to be?
*
Left
Center
Right
No part
What shampoo and conditioner are you using?
*
Are you using any hair styling products? If yes, please list them below:
*
What are your go-to styles?
*
Do you have a hooded dryer at home?
Yes
No
When is the last time you visited a salon?
*
Date or any approximate weeks
How often would you prefer to visit Style Queen Beauty The Salon?
*
Please Select
Every week
Every 2 weeks
Every 3-4 weeks
Every 2 months
Every 3 months
State of Hair
*
Natural
Relaxed
Tex-laxed
Transitioning
Keratin
Other
How long has your hair been in this state?
*
Date or any approximate weeks
Type of Hair
Straight
Curly
Wavy
Coily
Kinky
Current length of Hair* Please note, hair past shoulder length will incur a length fee
*
Short
Medium
Shoulder Length
Long
Hair Density* Please note, high density clients will incur a density fee
Low
Medium
High
Hair Condition
*
Normal
Dry
Oily
Scalp condition
*
Flaky
Dry
Itchy
Oily
Other
Do you have any diagnosed scalp conditions? (include all diagnosis and medication if applicable)
*
When was your last professional shape (cut) or reshape (trim)?
*
Date or any approximate weeks
How do you prefer for your hair to be cut?
*
Damp
Blow dried
Curly
Flat-Ironed
As recommended by stylist
How would you like your hair styled today?
*
Twistout
Updo
Curl Definition
Smoothing Service
Rodset
Twist and Curl
Other
What are your current hair concerns?
*
What are you looking for in a hairstylist?
*
Are you a cigarette smoker?
*
Yes
No
If yes, how much and how often?
*
Have you had any recent stress events?
*
Sickness
Mental Health
Trauma
Loss of a family member, friend, loved one
Work
Domestic Violence
N/A
Other
Please list all medical conditions
*
Diabetes, sickle cell, anemia, etc.
What is the approximate date of your last blood work?
*
Are you on any daily medications that may affect your hair color?
*
List medications taken daily
Do you have any allergies? (include all seasonal, food, medication)
*
Have you had any recent pregnancies, medical procedures or surgeries?
*
Yes
No
Are you pregnant? (Women)
*
Yes
No
Do you sweat in your sleep?
*
Yes
No
What type of sleeper are you?
*
Back
Side
Stomach
Unsure
Are you active?
*
Yes
No
If so, how often do you work out/engage in physical activity?
*
Are you on a diet?
*
Yes
No
How much water do you consume daily?
*
Are you interested in Hair Color?
*
Yes
No
Please upload an image of the hair color you want.
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Type of Hair Color Service Desired
*
Demi Permanent Color
Semi-Permanent Color
Permanent Color
Partial High Lights
Full Highlights
Fun Colors
None
Desired color
How often do you change the color of your hair?
*
Every month/Every 2 months/Quarterly/Yearly
Have you had double processed color before?
*
Yes
No
Have you used a permanent color before?
*
Yes
No
Have you used a semi-permanent color before?
*
Yes
No
Have you used a demi-permanent color before?
*
Yes
No
Do you wear a wig?
*
Yes
No
Do you use synthetic hair (braids, updos, etc.)?
*
Yes
No
Any special instructions or concerns not captured above?
*
Date Signed
-
Month
-
Day
Year
Date
Client's Signature
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