Hair/Scalp New Client Appointment Request Form
If question does not apply, please leave blank.
Name
First Name
Last Name
How do you prefer to be contacted?
Please Select
Text message
Phone call
E-mail
Email
example@example.com
Phone Number
Please enter a valid phone number.
Are you over the age of 18?
Yes
No
Which best describes the length of your hair:
Please Select
Very long (mid-back and below)
Long (below shoulders)
Medium (between chin and shoulder)
Short (above chin)
Which best describes the thickness of your hair:
Please Select
Extremely Thick
Thick
Medium
Fine
Very Fine
What service(s) are you looking for?
If seeking a color service, please briefly describe what you’d like done:.
If seeking a color service, has your hair been colored, highlighted, or chemically retextured (perm/straightening) within the past year. If so, what has been done?
If needing a scalp service, please briefly describe any scalp issue(s) you are experiencing and for how long:
For scalp service clients, what specific products are you using currently, and what products/services have you tried to remedy your scalp issues?
What days/times work best for your appointment?
When receiving a hair service or treatment, what is your social preference?
Please Select
Casual chit chat
I need to vent!
Less talk, just music
Less talk, silence
Depends on the day, I’ll let you know how I’m feeling
Please include any pictures you feel would be relevant (current hair, inspiration picture, scalp condition, etc)
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Who may I thank for referring you?
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