Chi Wins 2 Client Consultation Form

All information provided to Chi Wins 2 LLC (BEAUTY PARLOR) is kept confidential and is not sold to third parties.
Date

MonthDayYear
Date
First & Last Name
Birthday (M/D)
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Social Media: @
How did you hear about us?

Google (Please specify search term used below)
Name of friend/salon that referred you:
Current Hairstylist / Salon
Medical Conditions (Including alopecia, pattern baldness, thinning hair, etc.)
Medications (some medications may affect color)
Smoker (Heavy smoking may effect maintenance requirements of hair piece system)
What is your level of daily perspiration?
Physical Activities (Please check all that apply):

Other
ADDITIONAL INFORMATION
When out or at work do you regularly wear:
Rate your pain tolerance:
Do you have sensitive skin or any known allergies? If YES please describe:
Is your hair naturally:
Is your scalp naturally:
How often do you shampoo each week?
How often do you condition each week?
How often do you heat style each week? (Blow dry, flat iron, curl)
Please select all the tools/products you currently regularly use:
Would you describe yourself to be:
Do you have a bedtime haircare routine? (eg. Scarves, Braids, ponytail, damp hair, special pillowcase)
How many times in a 6 month period do you currently visit a hair care professional? (eg. Salon, Barber, Stylist, Colourist etc.)
What do you visit your hair care professional for?
Have you ever owned a hairpiece, wig, or extensions before?
If YES, please describe your experience.
Please describe the wave pattern of your natural hair:
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.*

Chi Wins 2
Should be Empty:

All information provided to Chi Wins 2 LLC (BEAUTY PARLOR) is kept confidential and is not sold to third parties.

ADDITIONAL INFORMATION