CE Customized Client Questionnaire
Name
*
First Name
Last Name
Date of Birth (For a fun gift every year)
*
Address
*
Street Address
Street Address Line 2
City
Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
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
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
-
Area Code
Phone Number
Email (we do not share info. this signs you up for our loyalty program & monthly newsletter)
*
example@example.com
How did you hear about The Cutting Edge Salon and Spa ?
*
Website / Online Search
Yelp
Facebook
Referral
Other
Other
If Referral, please list name
If Other, please let us know
When are you available?
Days only
Evenings only
Weekends
Anytime
Who is your Service Provider for upcoming reservation?
Please Select
Cindy
Linda
Nikki
Melanie
Michelle
Nathalie
Gina
Sharon
Julia
Not Sure
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?
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
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 list the Colour Services you are inquiring about.
*
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
*
We require your current hair now photos-take a selfie please
Upload your desired Hair results
What about this picture do you like?
Submit
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