New Client Intake Form

New Client Intake Form
Client's Name

First Name Last Name
Date of Birth

Month Day Year
Date
Client's Phone Number

Area Code Phone Number
Client's Email Address
example@example.com
Select a hair service

Adult Hair Cut Cut & Shampoo Hair color (Permanent) Toner (Semi) Color Correction Hair Conditioning Hair styling (Formal) Hair styling (Special Occasion) Perms Keratin Highlights Brazilian Blowout
Upload an image of hair style or hair color you prefer

Browse Files
You can upload multiple files here Cancel of
Upload an image of your current hair

Browse Files
You can upload multiple files here Cancel of
How often do you apply hair treatments?

Every week Every 2 weeks Every 3-4 weeks Every 2 months Every 2-6 months Twice a year Once a year
How long is your hair?

Short Medium Long
What is the current condition of your hair?

Hair loss Damage due to heat Split ends Breakage Itchy scalp Hair is dry Dandruff
What is the texture of you hair?

Fine Normal Thick Coarse Curly
How often do you apply shampoo and conditioner in your hair?

Every day Every other day Twice a week Once a week
Have you use the following in your hair before?

Professional Permanent hair color Keratin Treatment Box Dye or Sallys color Relaxer/Perm Henna
When did you last visit a hair salon?

Month Day Year
Date
When did you last apply professional or unprofessional color in your hair?
Are you taking any medications? If yes, please list them below:
Kindly list the hair products that you are using
What are the tools you are using to style your hair?
How did you hear about us?

Facebook Twitter Instagram YouTube Online Advertisement Google Search Referred by a friend Newspaper/Magazine
Any special instructions, comments, or suggestions?
By signing below, I agree to the terms and conditions of the salon company.
Client's Signature

Clear
Date Signed

Month Day Year
Date
Should be Empty:

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