2025 New Guest Intake Form

1
Full Name* This field is required.
First Name
Last Name
2
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
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
3
Phone Number* This field is required.
4
Email* This field is required.
example@example.com
5
Birth Month and Day (no year required)
6
Emergency Contact* This field is required.
First Name
Last Name
7
Emergency Contact Phone Number* This field is required.
Please enter a valid phone number.
8
Where did you hear about this salon?* This field is required.
Facebook
Instagram
Google Search
Newspaper/Magazine
Yelp
Referred by a friend
Pinterest
Other
9
Which digital resources of mine have you already checked out?
Website
Facebook
Instagram
Google
Yelp
10
What led you to searching for a new stylist?* This field is required.
11
Do you currently have any scalp or hair issues that concern you? (check all that apply)
Breakage from chemical services
Heat damage
Balding/thinning
Scalp irritation
Flakes/Dandruff
Manually pulling out hair
Open sores or wounds
Itchy scalp
Oily
Adverse reaction to color in the past
None of these
Other
12
Please select any of the following misc. options that apply to you.
Currently / recently pregnant
Taking medications for health
Nut/gluten allergies (or other severe allergies)
On a specific diet (i.e. vegan, keto, paleo)
None of the above
13
What products are you currently using at home (shampoo, conditioner, leave-in, etc)
14
What services or styles are you considering in the future?
Huge
Large
Normal
Small
Ok
Ok
15
What are some of your primary concerns with your hair?
Thinning
Oily roots
Dry Hair
Split ends
Breakage
Flaky scalp
Scalp irritation/burning/itching
Inconsistent curl patterns
Frizz
Lack of volume
Damage
Other
16
Have you colored your hair at home?
Yes, in the last 90 days
Yes, in the last 3 years
Yes, in the last year
Yes, but years ago
Never
17
Have you ever had an adverse reaction to hair color?
YESNO
18
Have you ever had a hair service you weren't happy with?
YESNO
19
How often would you prefer to come into the salon
Every 6-8 weeks
Every 2-4 months
2x per year
1x per year
As often as necessary to achieve my desired look
20
What is your anticipated budget for today?
Less than $150
Less than $250
Less than $350
Less than $450
$450+
21
How would you like to experience your service today
Low sensory (dimmed lights, spa music, minimal talking)
Low sensory but with chatting (dimmed lights, spa music)
Hybrid service (low lighting, but with upbeat music and chatting)
Regular service (normal lighting, upbeat music, catching up)
22
What would you like to drink today?
water
hot tea
coffee
sparkling water
Nothing today, thanks!
23
Would you like a complimentary scalp massage during your shampoo today?* This field is required.
Yes please!
No thank you
24
Got inspiration photos you'd like to share? Feel free to upload them here!* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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25
Please read through Eden Salon’s policies and confirm y oily understand and agree to these termsFind policies here: https://www.edensalondenver.com/etiquette
Yes I understand and agree to each policy
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