New Customer Registration Form

Guest Intake Form

Please fill out this form and I will be in touch to schedule your consultation. In your consultation, we will go into detail about your hair and discuss our plan to reach your hair goals.
Full Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
How did you hear about me?*
When is your Birthday? Month/Day*
Are you looking to change or refresh your current color?*
What services do you generally receive currently? (Select all that apply)*

HaircutDeep Conditioning TreatmentSmoothing TreatmentHair ExtensionsGrey Coverage Hair ColorAll over Hair Color, without any Grey CoverageHighlightsLowlightsBalayage Blonding
Please Select which one best describes the current condition of your hair.*

Very HealthyHealthy, with some minor split ends or drynessMildly comprimised, a little fragile from color/highlight processingOver processed/broken
Have you ever had an adverse reaction to hair color?*

YesNo
What day are are you best available? Select all that apply.*

TuesdayWednesdayThursdayFridaySaturday
What time of day are you best available? Select all that apply.*

Morning 9am - 12pmAfternoon 12pm-4pmEvening 4pm - 7pm
FUTURE APPOINTMENT CANCELLATION POLICY: In order to provide the best experience for all of my guests I ask that you please accept my cancellation policy. I understand emergencies happen, last minute things come up. I ask that you please be respectful of my time and give me a 48 hour notice if you need to cancel an appointment. If I'm not given proper notice I will require a payment of $50 per service scheduled. Thank you for understanding.*
Should be Empty:

Guest Intake Form