New Client Intake Form

New Client Intake Form

Please fill out prior to your appointment
Client*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
How did you hear about us?*

FriendFacebookInstagramWebsiteGoogle SearchOther
For any Color or Chemical Appointments
What type of water do you have at home?

City WaterWell WaterHard WaterUnknown
Prior Hair History (ex. prior color services, any reactions, breakage for any service, or any helpful information for our stylist)
By checking the following boxes, you confirm that you read and willingly consent to the following terms and conditions:*

I understand that if I am 15 minutes late or more for my appointment, that I will need to reschedule my appointment for another time.I confirm that the salon and/or the hairstylist will not be responsible or liable if the results of the service are not as expected.I am allowing the salon and/or hairstylist to apply necessary chemicals as part of the service. I understand that I can have an allergic reaction, and that I would need medical attention.I understand that the results of any chemicals can vary from person to person.I confirm that the hairstylist explained the plan of treatment, the benefits, the pros and cons during the consultation.I give consent to the salon to take any photographs of the service provided.I give consent to the salon to share any photographs to social media for marketing purposes or testimonials.I confirm and understand that kids are not allowed to be in the work service area for safety reasons.I understand that for certain services there is a non-refundable deposit due before the service is rendered. I understand that this deposit will be used towards my final bill and that the deposit will be forfeited if I cancel my appointment.I understand that there is a cancellation policy and I agree to abide by such policy. If I fail to cancel within the 48 hour time frame, there will be a cancellation fee. Please go to www.cupelesdesigns.com for more information on the cancellation/no-show policy.
I verify that the information I have provided on this form is truthful and accurate. I have read, understand, and checked all the terms and conditions. I release the beauty salon, stylists, nail techs, and all of the parties related to this beauty salon from any and all of the claims and demands including damages, diseases, and or injuries.
Date*

MonthDayYear
Date
Client Signature*

Clear
Please go to www.cupelesdesigns.com for any other

information, service list/prices, and cancellation policy.

Appointment Deposit

USDAppointment Deposit

Payment Methods

Credit Card

Apple Pay

Google Pay

Cash App Pay

Should be Empty:

New Client Intake Form

For any Color or Chemical Appointments

Payment Methods