New Client Intake Form
Your appointment is scheduled! I'm so excited to meet you. I'd love to get a few more details about your goals before your appointment. This helps me prepare for your appointment and allows us to get the most out of your consultation. Please fill this form out to the best of your ability.
Name
*
First Name
Last Name
Have you ever had an adverse reaction to hair color?
*
Yes.
No.
What type of water do you have at home? Select all that apply.
*
Well Water - Could smell metal or iron-y, leaves orange stains on tiles.
Soft Water - Could leave white/milky/discolored stains on tiles.
Hard Water - Could smell like bleach, leaves green residue on faucets.
Filtered Water - You have a Shower Head Filter that's been replaced in the last year.
Not sure.
In the last 2 years I have used.... select all that apply.
*
Gone to a professional.
Drugstore box color/permanent or demi color.
Bleached my hair at home.
"Toners" Such as Wella T18, etc.
Color Opps! Color Remover
Keratin Chemical Straightening Treatment
Henna/Organic Dyes ( ex: from Lush or Whole Foods dyes)
Relaxer
Perming
Sun-In
Semi Colors or Direct Dyes
Temporary Colors ( spray in colors that wash out )
Splat
Ion
Overtone
Brad Mondo Colors
Wen Hair Products
Monat or Modern Nature Products
Anything other products not listed?
*
Current hair products you are using? Shampoos, conditioners, heat protectants, oils etc! List them all!
*
How long has it been since you last had any chemicals done to your hair?
*
2+ Years
1+ Year
6+ months
4-6 months
2-3 months
1-2 months
Less than a month.
My hair is 100% virgin from root to tip.
How often do you get your hair cut?
*
2+ Years
1+ Year
6+ months
4-6 months
2-3 months
1-2 months
Realistically, how often would you like to be in my chair?
*
Once a year.
2x a year.
6+ months.
4+ months.
2-3 months.
6-8 weeks.
I want to see you every 4-6 weeks for touch-ups, treatments, me time.
How often do you wash your hair?
*
Every day.
Every other day.
3x a week
2x a week
1x a week.
I let to go past a week.
How often do you use heat tools? Blow drying/irons/etc.
*
Every day.
Every other day.
3x a week
2x a week
1x a week.
On occasions.
Rarely.
I never heat style my hair.
How often do you go into pool or salt water?
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Every day.
Every other day.
3x a week
2x a week
1x a week.
On occasions.
Rarely.
Never.
Are you on any prescribed medications or antibiotics? - Strictly confidential, no information is shared.
*
Yes.
No.
If selected yes - please list briefly of what: ( Ex: birth control, no need for exact names )
Any allergies to make me aware of? ( Ingredients, Fragrances, etc )
*
Yes.
No.
If selected yes - please list.
On a Scale of 1-10 , how happy are you with your hair?
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Hate it.
1
2
3
4
5
6
7
8
9
Obsessed.
10
1 is Hate it., 10 is Obsessed.
What is most important to you?
*
Achieving my hair goals as quickly as possible.
Maintaining the integrity of my hair and keeping as much length as possible!
How much does budget affect your hair choices?
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Highly - I will choose an option based on my budget.
Somewhat - I am willing to compromise based on what I want and upkeep
While I am price conscious, my vision for my hair won't change based on price.
My hair is something I want to invest in, because I am worth it.
Submit Me!
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