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New Guest Request for Haircut and Styling
. New Client Consultation Form
16
Questions
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1
Name
*
This field is required.
First Name
Last Name
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2
Phone Number
*
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Please enter a valid phone number.
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3
Email
*
This field is required.
example@example.com
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4
When is your birthday?
-
Date
Year
Month
Day
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5
Address
*
This field is required.
We will not send anything - for legality purposes only.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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
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
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6
How did you hear about us or find us?
*
This field is required.
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7
What are you currently struggling with the most?
*
This field is required.
Finding my signature haircut
Dry hair
Chemical damage
Dry scalp
Hair loss or thinning hair
Frizzy hair
Lack of volume
Oily or greasy hair
Dandruff
Split ends
Dull hair or lack of shine
Heat damage
Gray hair
Styling my hair
Using products
Scalp Therapy
Scalp Massage
Nothing, I’m happy with it!
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8
Please select ALL the services you may need
*
This field is required.
Extra Short Wash and Style
Extra Short Haircut
Short Wash and Style
Short Haircut
Medium Wash and Style
Medium Haircut
Long Wash and Style
Long Haircut
Extra Long Wash and Style
Extra Long Haircut
Consultation
Styling Lesson
Corrective Haircut
Scalp Care Treatments
Hair Care Treatments
Self Care Treatments
Formal Styling
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9
How often would you like to maintain your hair?
*
This field is required.
Once every 2 weeks
Once every month
Once every 2 months
Once every 3 months
Once every 6 months
Once every 2 weeks
Once every month
Once every 2 months
Once every 3 months
Once every 6 months
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10
Current Hair Uploads
*
This field is required.
Please upload 2 - 4 current pictures of your hair in the most natural lightening possible. No filters. Please note - all images uploaded are kept secure, confidential and private to A Signature Salon employees only. We require this to better understand how we can achieve your goals.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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11
Inspiration Hair Uploads
*
This field is required.
Please upload any images that you LOVE and would like your hair to look like.
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
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12
Is there a stylist you prefer to see?
*
This field is required.
Please take a moment to visit our website and check out the "About Us" section. You'll find profiles of each stylist, detailing their specialties. If you're unsure or would like our experts to assist you in finding the right match, simply select "No Preference." We're here to make sure your salon visit is tailored to your needs and preferences.
Please Select
Alanna Holy
Briley Blackman
Elizabeth Csaky
Melanie Pace
No Preference
Please Select
Please Select
Alanna Holy
Briley Blackman
Elizabeth Csaky
Melanie Pace
No Preference
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13
What days and times are you available?
*
This field is required.
Please select all that apply
Mondays
Tuesdays
Wednesdays
Thursdays
Fridays
Saturdays
8am - 12pm
12pm - 4pm
After 4pm
I am flexible
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14
What is your budget for this service?
*
This field is required.
Remember, first time appointments tend to be higher priced than a maintenance appointment. We are happy to work with your budget to meet your goals efficiently, effectively, and with integrity.
$50 - $100
$101 - $200
$201 - $300
I have no budget, I just want to achieve my goal right away
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15
What is the best way to contact you?
*
This field is required.
Text
Email
Social Media
Phone Call
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16
Is there anything else you’d like your stylist to know?
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