Style Queen Beauty New Client Consultation Form

Style Queen Beauty New Client Consultation Form
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Emergency Contact*

First NameLast Name
Emergency Contact Phone Number*

Area CodePhone Number
Emergency Contact Relationship*
Your Date of Birth*

MonthDayYear
Date
Marital Status*

SingleMarriedDivorcedOther
Current Occupation*
Instagram Handle*
www.instagram.com/yournamehere
Where did you hear about this salon?*

InstagramTwitterFacebookYouTubeOnline AdvertisementGoogle SearchReferred by a friendNewspaper/MagazineOther
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 appointmentEducation throughout appointmentClient will direct conversationStylist will direct conversation
Are you tender headed?*

YesNo
Where would you like your part to be?*

LeftCenterRightNo 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?

YesNo
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?*
State of Hair*

NaturalRelaxedTex-laxedTransitioningKeratinOther
How long has your hair been in this state? *
Date or any approximate weeks
Type of Hair

StraightCurlyWavyCoilyKinky
Current length of Hair* Please note, hair past shoulder length will incur a length fee*

ShortMediumShoulder LengthLong
Hair Density* Please note, high density clients will incur a density fee

LowMediumHigh
Hair Condition*

NormalDryOily
Scalp condition*

FlakyDryItchyOilyOther
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?*

DampBlow driedCurlyFlat-IronedAs recommended by stylist
How would you like your hair styled today?*

TwistoutUpdoCurl DefinitionSmoothing ServiceRodsetTwist and CurlOther
What are your current hair concerns? *
What are you looking for in a hairstylist? *
Are you a cigarette smoker?*

YesNo
If yes, how much and how often?*
Have you had any recent stress events?*

SicknessMental HealthTraumaLoss of a family member, friend, loved oneWorkDomestic ViolenceN/AOther
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?*

YesNo
Are you pregnant? (Women)*

YesNo
Do you sweat in your sleep?*

YesNo
What type of sleeper are you?*

BackSideStomachUnsure
Are you active?*

YesNo
If so, how often do you work out/engage in physical activity?*
Are you on a diet?*

YesNo
How much water do you consume daily?*
Are you interested in Hair Color? Please note a Check the Tress Consultation must be booked prior to this service being performed. Color services are not conducted during a first appointment.*

YesNo
Please upload an image of the hair color you want.

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Type of Hair Color Service Desired*

Demi Permanent ColorSemi-Permanent ColorPermanent ColorPartial High LightsFull HighlightsFun ColorsNone
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?*

YesNo
Have you used a permanent color before?*

YesNo
Have you used a semi-permanent color before?*

YesNo
Have you used a demi-permanent color before?*

YesNo
Do you wear a wig?*

YesNo
Do you use synthetic hair (braids, updos, etc.)?*

YesNo
Any special instructions or concerns not captured above?*
Date Signed

MonthDayYear
Date
Client's Signature

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