Your Information

New Client Intake Form
All About You!

Help me get to know you before your appointment!
Your Name

First Name Last Name
Birth Date

Month Day Year
Gender

FemaleMaleOther
Email
example@example.com
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
How did you hear about AtomicApril Hair Studio?

Website / Online SearchSocial MediaReferralOther
If you were referred, who referred you?

First Name Last Name
Service you are booked for:
Hair History

If you are unsure if any apply to you, please check box and put notes in box provided below.
Please check any of the following that apply

I have a sensitive scalpI have thyroid issuesI have hair dye on my hair from dyeing my hair at home.I take heart medicationI have hair dye on my hair from dye in a salonI wear extensions/have worn in past 6 monthsI Have Had a Chemical Straighter (Keratin or Brazilian Blowout, Perm)I have/ had a medical condition that affects my hair, scalp, hair product sensitivity.Ive bleached my hair in the past 2-3 yearsIve bleached my hair in the past yearI have never had hair color on my hair ever.My hair sheds exessivelyMy hair is very dry and brittleMy hair has lost its lusterMy hair is excessively oilyI have dryness, dandruff or flakes.Other
If you checked any of the boxes above, please provide further information.
Is there any other condition or information you would like to share about your hair and/or beauty vision that you would like to achieve?
What do you LOVE about your hair? What would you like to see different?
Submitting this form I acknowledge and agree:

I will be charged according to the cancellation policy for less than 24 hour cancellations and no-shows - This is 75% of the total service booked.I have reviewed all prices for the services I have booked ( to review, please see atomicaprilhair.com)If I downgrade my service to within 24 hours of my appointment I will be charged for the cost of the original service booked.A major credit card is required to hold and confirm all appointments. No card - No appointment.
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New Client Intake Form

All About You!

Hair History