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New Guest Request Form
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1
Name
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First Name
Last Name
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2
What are your pronouns?
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She/Her
He/Him
They/Them
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3
Email address
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(Please be sure this is an email you check often, as this will be how I contact you)
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Complete mailing address
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5
Phone Number
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Please enter a valid phone number.
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6
Birthday month
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7
How did you hear about me?
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If through a referral, please share their name so I can thank them!
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8
How many months do you reside in Florida yearly?
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I am just visiting
3 months or less
4-8 months
Year round
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9
My last haircut was
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1-2 months ago
3-6 months ago
6-12 months ago
1+ year
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My last color application was
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In a salon
At home
I haven't colored my hair in 3 years or more
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11
What services are you seeking? Check all that apply. (You can get more in depth in in a later section)
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In salon color consultation
Haircut
A major haircut change in length and/or style
Root retouch/Gray coverage
All over color (root to ends, single process color)
Partial highlights (front, sides, and top for brightness)
Full highlights (foils throughout your entire head)
Lowlights
Uneven color rebalancing
Eyebrow shaping
Eyebrow tint
Customized deep conditioning treatment to restore moisture, shine, smoothness and elasticity
Scalp treatment to lift aged cells and impurities while balancing and conditioning the hair and scalp
Other
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12
What is your availability ?
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First available appointment
Tuesday AM
Tuesday PM
Wednesday AM
Wednesday PM
Thursday AM
Thursday PM
Friday AM
Friday PM
Saturday AM
Saturday PM
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13
Have you ever had an allergic reaction to any salon service or product? If yes, please explain.
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14
How long is your hair currently?
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Pixie (very short)
Short (above the chin)
Medium (chin to shoulder length)
Long (past shoulders)
Extra long (middle of the back or longer)
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15
How thick is your hair?
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Fine/Thin
Normal Density
Thick/Coarse
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16
Which of the following best describes the texture/wave pattern of your hair if AIR DRIED naturally?
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Mostly straight
Wavy
Curly
Extra Curly (very tight coils)
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17
I do this 2 or more times a week (check all that apply)
Wash my hair
Blow dry my hair
Use a flat iron
Use a curling iron or wand
Pull my hair up in a ponytail or bun
Use hair treatments
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18
I am currently experiencing the following challenges (check all that apply)
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Breakage
Dryness
Frizz
Dullness
Dandruff
Skin conditions or rashes
Hair thinning
Bald spots
Bumps, scabs, or sores on my scalp
None of the above
Other
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19
I sometimes have the following styling challenges (check all that apply)
My hair falls flat after styling
My hair is frizzy after blow drying
When I use a flat iron, I often have to go over the same section multiple times
When I curl my hair, the curls don't turn out right and/or last
I can't achieve enough volume or body to my style
My scalp is oily
My ends are dry
I'm not sure if my stying products are the right fit for my hair needs
I have no current styling challenges.
Other
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20
I currently use the following brand(s) of shampoo and conditioner
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21
I currently use the following styling products
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22
What is your NATURAL hair color? If you're mostly gray now, what was your natural color before?
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Blonde
Light Brown
Brown
Very Dark Brown or Black
Red
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23
The last time I colored my hair, I
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*If the hair currently on your head has undergone ANY chemical services within 1-3 years, (color, highlights, perm, henna, anything) please select. Even if it has faded out.
Colored it all over brown or black
Did a retouch (root area)
Did a retouch (color at my roots) along with highlights
Highlights only
Went red
Bleach retouch (full blonde root retouch)
I haven't colored my hair in 3 years or more
Other
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24
Please upload 2-3 photos of your hair currently, (front, sides, and back).
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Lighting is crucial! The best light is indirect, natural sunlight, such as facing a window or outdoors in the shade. (No direct sunlight or filters please). Include hair from root to tip.
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Max. file size
: 10.6MB
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25
Upload a photo of your dream hair.
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While no single photo can capture everything you like, please share any inspiration photos you may have for your ideal end result. I would love to see the color, length, and/or style you're looking to achieve.
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Max. file size
: 10.6MB
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26
What additional information would you like me to know about your hair history and/or goals?
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27
COVID-19 Waiver
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I acknowledge the contagious nature of the Coronavirus/COVID-19 and that the CDC and many other public health authorities still recommend practicing social distancing. I further acknowledge that Selphness Hair Studio has put in place preventative measures to reduce the spread of the Coronavirus/COVID-19, and all other communicable diseases/infections. I further acknowledge that Selphness Hair Studio can not guarantee that I will not become infected with the Coronavirus/Covid-19 or any other communicable disease/infection. I understand that the risk of becoming exposed to and/or infected by the Coronavirus/COVID-19 or any other disease/infection may result from the actions, omissions, or negligence of myself and others, including, but not limited to, salon staff, and other salon clients and their families. I voluntarily seek services provided by Nicole Selph of Selphness Hair Studio and acknowledge that I am increasing my risk to exposure to the Coronavirus/COVID-19. I acknowledge that I must comply with all set procedures to reduce the spread while attending my appointment. I attest that: * I am not experiencing any symptoms of illness such as cough, shortness of breath or difficulty breathing, fever, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell. * I have not traveled internationally within the last 10 days. * I do not believe I have been exposed to someone with a suspected and/or confirmed case of the Coronavirus/COVID-19. * If I have been diagnosed with Coronavirus/Covid-19, I have been cleared as non contagious by state or local public health authorities. * I am following all CDC recommended guidelines as much as possible and limiting my exposure to the Coronavirus/COVID-19
I agree.
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28
CANCELATIONS &/OR RESCHEDULING: Your appointments are very important to me and are held just for you. If circumstances arise that make it necessary for you to adjust or cancel your booked appointment time, I kindly ask that you provide at least a full 24 hours notice. This ensures flexibility in managing my appointments with other guests, and allows for adequate time to fill that space. If proper notice is not given, a fee of 50% of the scheduled service(s) will be applied, with a $30 minimum, and will need to be paid prior to rescheduling.
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I accept
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29
PUNCTUALITY: If you are running 15 minutes late or more your appointment may need to be rescheduled or may require a portion of your service to be forfeited. It is understood that emergency situations can arise and I will try to accommodate you in any way that I can. Circumstances that call for rescheduling will be treated like a last minute cancellation and may be subject to the cancellation fee.
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I accept
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30
CONTACTING ME: All text messages and calls are for appointment day arrivals. To contact me regarding any scheduling requests, appointment changes, or questions, please email me at SelphnessHairStudio@gmail.com. Messages will be replied to within 24 business hours.
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I accept
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31
APPOINTMENT CONFIRMATIONS: You will receive an appointment confirmation 3 days prior to your appointment via email and/or text with instructions to confirm your appointment. Please follow the instructions to do so.*Be advised: these are automated text messages and Selphness Hair Studio does not receive any text messaging.
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I accept
Other
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32
PRICING: All published prices are starting points for services. Prices may vary due to certain factors such as: the hair’s length, density, and condition; the complexity of the service; and the amount of product being used.
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I accept
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33
SERVICE SATISFACTION: I strive to offer my guests the highest level of guest satisfaction. If you are having challenges with your cut or color, please let me know within 4 days of your visit and I will be happy to correct the issue with no additional charge. The revision policy does not include a full change in the original and agreed upon service, and any revision requests made after the 4 day period from the original service date will be subject to my approval. While this is rare, it is important to communicate my policy.
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I accept
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34
FINISHED RESULTS: Because results are most accurately evaluated on hair that has been dried, smoothed, and properly finished, services are only guaranteed when the hair is blown dry in the salon. If you opt to leave the salon without a styling service, you are relinquishing your rights to the revision policy.
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I accept
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35
ILLNESS: In order to provide a healthy and safe environment, please reschedule your appointment if you are not feeling well or have exhibited flu-like symptoms over the past 72 hours, or if a member of your household is ill. Please DO NOT arrive at your appointment if you are sick or are starting to feel symptoms of being sick, as your appointment will be cancelled.
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I agree.
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36
CHILD CARE: To preserve an environment that promotes relaxation, please make arrangements to have children cared for during your service. Children are not permitted in the salon unless they are receiving a service and cannot be left unattended.
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I accept
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