New Client Consultation Form

New Client Consultation
Name

First NameLast Name
Date of Birth Month/day
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
Email (we do not share info )
example@example.com
How did you hear about Timeless Beauty?

Other
If Referral, please list name
If Other, please let us know
Who is your Service Provider for upcoming reservation?
Your Hair Profile
What are your hair care goals?
What are your hair care challenges?

Other
What are you trying to achieve with your style?

Other
Average visits to a salon:
What is your daily hair routine?
How much styling time is spent at home?
What is your home styling comfort level?
What kind of styling tools are you using at home during your hair routine?

Other
Hair Versatility
Have you ever had a clarifying or hydration conditioning treatment service before?
What hair care products do you currently use?
What do you wish your hair did more of?
Hair History

Sometimes daily routines 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 the items that may effect your services.

Other
Do you presently have any breakage, thinning or bald spots?
Have you ever had an allergic reaction to a product or oils?
If yes, please explain
Please select any of the following chemical hair services you’ve received either professionally or at home.
Have you ever experienced hair loss or scalp problems?

Other
Is your hair Color treated? (including color rinses, box dye, etc)
Please feel free to go into more detail about any questions you may have for your stylist
Have you ever received a chemical straighter or relaxer service or treatment?
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 to hair services being received.
Signature
Please take a couple hair selfies (front, side & back) This is optional but helps determine price and time needed to complete your service. Prices are based on length and density
Should be Empty:

New Client Consultation

Your Hair Profile

Hair History

Please select any of the following chemical hair services you’ve received either professionally or at home.