Client Request Appointment Form

Appointment Request Form

Thank you for your interest in making an appointment with me! This form will help me clarify your specific needs so I can book your correct services. Booking the right services allows us the right amount of time to get you to your hair goals effectively. It is my priority to conduct customized consultations for all services provided. However, it is the client’s personal responsibility to be upfront and honest about their hair history. Any damage caused to the hair as a result of withheld information when filling out this form and during the consultation is NOT my responsibility. If you are a new customer looking to schedule an appointment, please review the services and fill out form below. Once I receive the form I will be in contact through text message to book your appointment within a few days! Thank you!
Personal Information
Client Name

First NameLast Name
Birth Date

MonthDayYear
Email
example@example.com
Phone Number
Please enter a valid phone number.
How did you hear about us?

Website / Online SearchSocial MediaReferralOther
If you were referred please list the name below..
Do you have any allergies or medical conditions I should know about? (certain medications, treatments, and medical conditions can effect the way color processes. They can also cause reactions. ) Please be specific and list below.
What is the best availability for your appointment?

Weekday morningsWeekday eveningsNo preferenceSaturdaysOther
If other please specify what days and times work best..
Please select all services you are interested in.

Highlights/BalayageGlazeGray Coverage/Single ProcessHaircutBlow OutConditioning TreatmentBrazilian Blowout / Keratin TreatmentsWhole Head Single ColorDimensional Color (Lowlights added)Hair Extensions (For Volume or Volume and Length)Unsure, I'd like your opinion.
If you are interested in extensions please select what type.

NONEWefts (Volume or handed)Tape InI-TIPK-TIPNot Sure
How often do you shampoo?
Are you currently using professional products at home? Please list your shampoo, conditioner, and products used.
How would you describe your current hair? List all that you think may apply.

FineThickShortMedium LengthLong (past the collar bone)Thinning/hair lossoilydry
Have you received any of these services listed below within the last couple of years? (Please select all that apply)

At Home ColorHighlights/Balayage/Any Lightening ProcessPerm or Relaxer/StraighteningKeratin TreatmentMagic Sleek or Pro Addiction TreatmentFantasy ColorsGlaze/TonersHenna ColorPermanent Hair color (Used for Gray Coverage)ExtensionsNONE OF THE ABOVE
When was your last color or chemical service?
Do you have well water?

YesNoNot Sure
REFUNDS - I DO NOT offer refunds of any kind. If for whatever reason you are unhappy with your service PLEASE let me know within 5-7 days. I will do everything in my power and knowledge to accommodate you. My goal is always to make sure your hair is kept with the best integrity and you are happy leaving my chair! I cannot guarantee color, treatments, or health of hair if you are not using recommended products at home and you are not honest about your hair history.

I acknowledge and consent to the refund policy.
I require a credit card to be held on file to schedule any appointments. Your card will NOT be charged unless you cancel your appointment outside of the cancellation policy window.

I consent to my card being held on file and acknowledge that my card will not be charged unless I cancel outside of the cancellation policy window.
LATE POLICY - I book the perfect amount of time needed for each service booked. Out of respect for myself, you, and for other clients, PLEASE come on time. Late arrivals exceeding 10 minutes may result in rescheduling or service adjustments. If possible I will do my best to alter your services so that I can offer you an appointment. Late arrivals that result in rescheduling might result under cancellation policy. Thank you for understanding!

I acknowledge and consent to the late policy.
CANCELLATION POLICY / RESCHEDULING / NO SHOW - To be fair to you, to myself, and other clients, I require a minimum 48 hours notice to cancel or change any appointment. Cancellations on short notice make it hard for me to protect my time and accommodate other clients possibly waiting for that spot. CANCELLATIONS MADE WITH LESS THAN 48 HOURS NOTICE will be charged 50% of the services booked to their credit card on file. SAME DAY CANCELLATIONS/NO SHOWS will be charged 100% of the services booked. MULTIPLE CANCELLATIONS OR NO SHOWS will NOT be booked for future appointments. NO EXCEPTIONS.I know and completely understand things happen, people get sick, and we all run late or things slip our minds. This is why I will make sure you get a confirmation text/call days prior to your appointment.

I acknowledge and consent to the cancellation policy and that it is my responsibility to cancel or reschedule 48 hours before the starting time of my scheduled appointment. Also, if I cancel with less than 48 hours notice, I will be charged 50% of the services booked. If I cancel same day or no show, I will be charged 100% of services booked.
After your form is submitted I will be reaching out to you and we will talk about your hair now and what your hair goals are during our consultation.

CONSULTATIONS
In your consultation we will go over again your hair history, lifestyle, products, and hair goals. Some colors may need multiple appointments and time to get to your main hair goal. This depends on natural hair color and texture, color history, health of hair, and desired color. It is always good to have photos of anything you LOVE or photos of anything you DO NOT love so we are always on the same page. It Is also smart to look for photos of hair similar to your length and fullness for realistic expectations (unless your end goal is EXTENSIONS which are fabulous for adding volume and/or length and also pops of color) I can’t wait to make your hair dreams come true!

PLEASE HAVE RECENT "BEFORE" PICTURES OF YOUR HAIR AND PICTURES OF FUTURE HAIR GOALS READY FOR WHEN I REACH OUT! THANK YOU!

Thank you, Rebecca
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Appointment Request Form

Personal Information