Client Intake Form

  • Client Intake Form

    Fill out the form carefully, which includes the your basic information, Wellness Screening, and the Hold Harmless Agreement.
  • Format: (000) 000-0000.
  • Are you requesting any of the following services?
  • How do you wear your hair?
  • How would you rate your hair's condition?
  • Browse Files
    Drag and drop files here
    Choose a file
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  • Wellness Screening

    Waiver
  • Are you feeling sick or ill as of today?
  • As of today, do you have a fever of 99 or above?
  • Have you been in contact/exposed to someone who has tested positive for the Coronavirus within the past 10 days?
  • Have you traveled outside of the state within the past 10 days?
  • Have you been vaccinated for the Coronavirus?

  • Hold Harmless Agreement

  • I, agree to assume the risk of any injury or damage that I may suffer because of such negligence or carelessness. I agree to give up my right to sue the operator, the salon, and any other personnel for any such injury or damage caused by my negligence. I have carefully read this agreement. I fully understand this agreement and are hereby stating that I am of sound mind. I also understand that this is a release of liability and I sign this of my own free will.

  • Requested Appointment Date
  • Should be Empty: