New Client Intake Form
Hair by Niah Percia
Name
First Name
Last Name
Email
You will be contacted via email.
Phone Number
Please enter a valid phone number.
Birthdate (Please note, I only work on clients ages 13+)
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Month
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Day
Year
Date
Occupation
What is your natural hair type?
Straight
Wavy
Curly
Coily
How would you describe the density of your hair?
Fine
Medium
Thick
How would you describe your scalp?
Dry
Normal
Oily
What is your current hair length?
Short
Shoulder length
Midback
Lower back
Is your hair natural or relaxed? Please note, as a natural specialist, I only accept transitioning relaxed clients.
Natural
Relaxed
How would you describe your hair?
Healthy
Slightly damaged
Damaged
How often do you shampoo and condition your hair?
Daily
Every other day
Weekly
Bi-weekly
Monthly
How often do you deep condition your hair?
Daily
Every other day
Weekly
Bi-weekly
Monthly
What hair products/brands are you using?
What are your long term hair goals?
Have you ever had your hair colored before? If so, list when and any other details.
Please list any more hair history you would like to be noted.
Are you sensitive to or have you suffered a reaction from any hair/scalp treatments or chemicals?
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Yes
No
If yes please list here:
Are you currently taking any prescribed or over the counter medications?
Yes
No
If yes please list here:
What is your stress level on a scale of 1-10?
What is your average daily water intake?
Please list the service(s) you are interested in.
*
Please upload a 2-3 photos of your natural hair. (good lighting, no bun photos)
*
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