New Guest Appointment Request

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Instagram Handle
4
Pronouns
He/him
She/her
They/them
Other
5
Birth Month and Day* This field is required.
6
Phone Number* This field is required.
Area Code
Phone Number
7
Address* This field is required.I occasionally drop a little something in the mail for my guests, but will not send junk mail.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
8
How did you find Jessica Bautista?* This field is required.
Instagram
Facebook
Google
Yelp
Local Business
Met in Person
Referral
Social Media
9
If a referral, please let us know who to thank!
10
Check off all of the services you think you may need.* This field is required.
Haircut
Clipper Cut
Conditioning Treatment
Product Recommendations
Styling Lessons
Energy Healing
Scalp Treatment
Hard water detox
Gray coverage
Highlights
All over color
Other
11
Based upon Jessica's Service Menu, what Service Package are you thinking you may need?* This field is required.The service menu with descriptions of each package can be found at https://www.jessicabautistahairstylist.com/services.
Nourish $78+
Maintain $198+
Refresh $126+
Transform $226+
Specialty Color $95/hour
I'm not sure.
Other
12
How would you describe your hair's curl pattern?* This field is required.
Straight
Wavy
Curly
Coily
Other
13
How would you describe your hair texture?* This field is required.Texture refers to the diameter of each hair strand.
Baby Fine
Fine
Medium
Thick
Extra Thick
Wiry
14
How would you describe your hair density/thickness?* This field is required.Density refers to the number of hairs per square inch of scalp.
Actively thinning
Thin
Medium
Thick
Extra Thick
15
Hair Length Chart
16
In the state that you wear it most often (Natural, Straightened, Smoothed, Curly etc.), How would you describe your hair length?* This field is required.
Short
Medium
Long
Extra Long
17
Your hair history within the last 3+ years.* This field is required.No judgement here- I need this info to take the best possible care of you and your hair.
I have colored my own hair.
I have not colored my hair in 3+ years.
I have gotten my hair colored professionally.
Other
18
What hair color/product was used on your hair? Please Check all that apply.
Professional Color
Box Dye
Bleach/Lightener
Overtone
Temporary Hair Color Rinse
Temporary Fashion Colors
Henna
Not sure
Other
19
Please upload photos of the front and back of your current hair in natural light. * This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
20
Please upload at least one inspiration photo.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
21
Emergency Contact Information* This field is required.
Name
Phone
Relation
22
Do you have any allergies, medical conditions, injuries, sensitivities, or pain that may impact the outcome of, or your ability to tolerate, your services, or the health of your hair?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
23
Do you have any questions for me or anything else you'd like to share?
Huge
Large
Normal
Small
Ok
Ok
24
I have read, understand, and agree to all policies detailed in this form.* This field is required.
25
Please verify that you are human* This field is required.
Should be Empty: