New Client Form

Welcome to GEMPIRE Holistic Hair Company.

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I invite you to complete the following intake form. This information will help me determine if I am best aligned for your hair journey.

If approved, GEMPIRE HHC will forward you additional information on how to secure the appropriate amount of time for your hair reservation. If the services you require are outside of Gabrielle's *genius zone* she will forward you some incredible artists that will best fit your hair needs.

Name* This field is required.

first name

last name

Pronouns* This field is required.

Phone* This field is required.

E-mail* This field is required.

example@example.com

How were you referred to GEMPIRE Holistic Hair Company?* This field is required.

Instagram

Facebook

Google

Yelp

Referral

Other

If you were referred, who referred you?* This field is required.

Describe your lifestyle and how your hair fits into it* This field is required."I love styling my hair, I use heat protecting products and use a wand to curl my hair twice a week!" "My life is on the go. I mix up my heat styling and air drying routine." "I wash once a week and exclusively air dry."

What do you LOVE about your hair?!* This field is required.

What do you wish you could change about your current hair?

How much time are you willing to spend on your hair each day?* This field is required.

5 Minutes

10 Mnutes

15 Minutes

As Long as it takes

Which reservation best fits your needs?* This field is required.

30 Minute Virtual Consultation about Holistic Haircare, Scalp, and Hair Health

Hair Revival (Haircut & Treatment ONLY)

Color (Color & Treatment ONLY)

Color & Hair Revival

Tricho-Derm Scalp Analysis

Halo Couture Color Match Consultation

Halo Couture Revival (Drop-Off Service)

Which color service best fits your needs?* This field is required.

Maintenance Color

Full Transformation

Color Correction

I don't need color, haircut only

Please select ALL services that fit your needs:* This field is required.

Single Process Color- Root Touch up

Single Process Color- Roots & Refresh Ends

Single Process Color- Root Touch up (grey coverage/blending)

Single Process Color- Roots & Refresh Ends (grey coverage/blending)

Traditional Foil Highlights

Balayage/Foilayage (custom highlighing for low maintenance grow out)

Add Dimension

Brighten Ends

Shadow Root

Glaze (toner)

Platinum / bleach and tone

Vivids / Fantasy colors

Color Correction

Other

Please describe your color history:* This field is required.Please elaborate on your color journey over the last 5 years - Color Services: Professional, At- Home or Both. IMPORTANT: If you've had ANY *BOX* or *HENNA* color in the last 10 years, please make sure to include as much detail about your hair during that time.

Please upload pictures of your current hair PRODUCTS here:* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Please describe why you're in search of a new stylist/ experience?* This field is required.(ie: Moved to a new city, wanted a fresh set of eyes, looking for a more intimate studio setting, etc.)

Have you experimented with color conditioner (i.e overtone) on your hair in the last year?* This field is required.

Yes

Would you like to experice a Hair Revival as well?* This field is required.(Haircut or Trim, Mending and Treatment)

Yes

Please upload your Color Inspiration image(s) here:

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Which Hair Revival Services best fit your needs?* This field is required.

Dry Haircut / Bang Trim (no shampoo/style)

Maintenance Trim & Mending

Transformation Haircut

Corrective Haircut

Other

None of the above, I want color only

Please upload your haircut INSPIRATION image(s) here:

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Are you currently experiencing any of the following challenges with your hair/scalp?* This field is required.

Feels Incredible!

Dry

Brittle

Damaged and Defeated

Fuzzy/ Frizzy

Dull/ Lacking shine

Flat/ No Volume or Texture

Thinning

Hair Recession

Oily Scalp

Dry Scalp

Itchy Scalp

Red Scalp

Are you open to having Gabrielle customize a hair treatment for you during your visit?* This field is required.

Absolutely!Not this time

Are you open to energy healing alongside your custom treatment? * This field is required.

Yes, please!Not this time

How long is your hair?* This field is required.

Pixie Length

Chin Length

Shoulder Length

Mid Back Length

Lower Back or Longer

How would you describe the texture of your hair? * This field is required.

Straight

Wavy

Curly

Tight Curls

How would you describe your individual hair strand?* This field is required.

Fine

Medium

Coarse

Unsure

How big is the circumference of your ponytail (overall density)? * This field is required.

Hair is too short for ponytail

Less than a dime size

Dime size

Nickel Size

Quarter Size

Larger than a Quarter

Unsure

Please upload the MOST RECENT photo(s) of your hair here:* This field is required.Helpful tip: Photos are best taken in natural light or in the bathroom mirror. Front, Side, and Back!

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Please take a moment to express anything that may not have been touched on here:(Questions, Concerns, etc)

Please review GEMPIRE's policies (including cancellation, refund, and late policies)* This field is required.

I agree with GEMPIRE Holistic Hair Company's Policies