Customer Details:
All details are stored in accordance with my GDPR privacy policy is available to view on my website www.rebeccabanham.co.uk
Full Name
*
First Name
Last Name
How did you hear about me?
*
Please Select
Internet search
Recommended by a friend
Other (Please specify in box below..)
Email (leave blank if I already have these details)
example@example.com
Mobile phone number
Leave blank if i already have your number.
Do you consent to me storing your data in accordance with my privacy policy.
Yes
No
Do you consent to a before & after picture of your hair (face can be covered if you wish)
Yes
No
Emergency contact details
Phone number
Please enter a valid phone number.
Back
Next
About you and your hair...
On your hair appointment what would like to achieve?
Big restyle?
Just a tidy up?
New colour?
Complete tranformation?
Extra info please type here....
Do you have any allergies or take any medications or long term health conditions that may affect your hair?
Yes
No
Unknown
If yes please answer below-
Your hair type-
Fine
Thick
Frizzy
Curly
Straight
In good condition
Condition needs improving
Brassy tone
Other
If ticked other please write below..
Do you have any scalp concerns dandruff etc...
Yes
No
Not sure
If yes please comment in the box below.
Any other information that may be useful before I see you in the salon. If possible please send me a picture of you hair in good lighting along with any inspiration pictures you may have ( at lease 3 inspo pics)
Client signature
Clear
Thanks for completing this form.
I look forward to seeing you soon!
Submit
Should be Empty:
Now create your own Jotform - It's free!
Create your own Jotform