Billie Jean Styles Client Questionnaire
Name
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
How did you hear about Billie Jean Styles?
*
Website / Online Search
Insagram
Facebook
Referral
Other
If Referral, please list name
If Other, please let us know
Would you like to do a virtual consultation over zoom or in person at the salon?
Zoom
Salon
Your Hair Profile
What challenges are you currently facing with your hair and scalp? Explain
Including salon visits how often do you shampoo your hair?
How often do you plan to come to get your hair done?
What is the ideal day and time for you for hair appointments?
Are you interested in making standing appointments?
Do you have any gray hair? If so are you interested in covering the gray with rinse or permanent color?
*
When is the last time you had any of the following services? Rinse Permanent Color, Relaxer Straightening System, Haircut or Trim, Protein Treatment, or Olaplex Treatment
*
What is the ultimate goal for your hair? Including style, length, color, density.
Hair History
We have all done crazy things with our hair! Sometimes our daily routine will effect the outcome of your hair service. We just want to make sure your service will have the best results. So please be truthful and honest with the following questions. We don't judge.
Are you currently taking any prescriptions, vitamins, or hormones? If yes please list them.
Have you ever experienced hair loss or scalp problems?
No
Yes
Do you have any mineral deficiency? For example iron, vitamin d etc
No
Yes
Do you presently have any breakage, thinning or bald spots?
*
No
Yes
Not sure
Are you allergic to anything? If yes, explain
Please feel free to go into more detail about any questions you may have for your stylist
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the hair service being received.
*
Yes
Signature
*
Clear
Please take a couple hair selfies!
Upload some desired Hair results
What about this picture do you like?
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