New Guest Application

1
First Name * This field is required.
First
2
Last Name* This field is required.
Last
3
What are your Pronouns?
He/Him
She/They
He/They
They/Them
She/Her
4
Phone Number * This field is required.Please note, we will send important text updates and appointment confirmations
Area
Phone Number
5
What is your email address?* This field is required.Please note, we will be reaching out by email for your next steps
example@example.com
6
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
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
Curacao
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
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
7
What is your birth date ? Month/Day/Year
00/00/00
8
How did you find Pure Indulgence?* This field is required.
Instagram
Facebook
Google
Yelp
Local Business
Met in Person
Referral from Friend
Social Media
9
What services are you looking to book at your first appointment?* This field is required.Check all that apply
Grey Coverage
Full Head Highlights
All Over Lightening
All Over Darkening
Haircut only
Clipper Cut
Partial Highlights (face framing, top and sides)
Conditioning Treatment
Haircut with Color Appointment
Styling Lessons
Eyebrow Wax
Eyebrow Tint
Clarifying Treatment
10
What's the name of your friend who referred you?
11
Are you ONLY looking to book a haircut?I currently do not accept any new "Haircut Only" guests. You must be getting a color done with your service in order to recieve a haircut/appointment.
YESNO
12
New Client Service Sessions
13
Based on Pure Indulgence Service Menu, what Service Package are you thinking you may need?* This field is required.
New Guest Refresh $150
New Guest Maintain $195
New Guest Upgrade $225
New Guest Nourish (Haircut) $65
14
How would you describe your hair density/thickness?* This field is required.
Extra Light
Light
Light - Medium
Medium
Medium Heavy
Heavy
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
In the past 3 years, what coloring services have you had done? Select all that apply.* This field is required.
I have colored my own hair. (box color at home)
I have not colored my hair in 3+ years.
I have gotten my hair colored professionally. (in a salon)
This is my first time coloring my hair
18
What hair color/product did you use? Please Check all that apply.* This field is required.
From Sally's Beauty Supply
From Online
From Drugstore/Grocery Store
Box Dye
Splat
Overtone
Temporary Hair Color Rinse
19
Please upload a photo of your current hair (please no bathroom pics, no filters, no direct sunlight)* This field is required.Front
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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20
Back
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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21
Please now upload some inspiration pics (no filters)Inspiration Pic 1
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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22
Inspiration Pic 2
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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23
What is your budget for this appointment?
$150 - $200
$200- $300
Less than $100
no budget/doesn't matter
24
How often do you typically visit the salon?* This field is required.
every 4-6 weeks
every 6-8 weeks
every 8-10 weeks
as often as needed
once or twice a year
almost never
25
Tags
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