New Client Appointment Request

New Client Appointment Request
Client's Name*

First NameLast Name
Client's Phone Number*

Area CodePhone Number
Client's Email Address*
example@example.com
Select a hair service*

ExtensionsColorNatural Hair
What is your ultimate goal for your hair?*
Upload an image of the style you would like to achieve*

Browse Files
You can upload multiple files here Cancelof
Upload an image of your current natural hair front*

Browse Files
You can upload multiple files here Cancelof
Upload an image of your current natural hair back*

Browse Files
You can upload multiple files here Cancelof
How often do you go to salon for hair treatment?*

Every weekEvery 2 weeksEvery 3-4 weeksEvery 2 monthsEvery 2-6 monthsTwice a yearOnce a yearOther
How long is your hair?*

ShortMediumLongOther
What is the current condition of your hair?*

Hair lossDamage due to heatSplit endsBreakageItchy scalpHair is dryDandruffOther
What is the condition of your scalp?*

DryNormalOilyOther
How often do you Shampoo and Condition?*

Once a weekEvery two weeksOnce a monthOther
Have you used the following in your hair before?*

Permanent hair colorKeratin TreatmentRazor cut/ThinningRelaxerHennaOther
When did you last visit a hair salon?*

MonthDayYear
Date
When did you last apply professional or unprofessional color in your hair?*
Are you currently taking medications?*

YesNo
Please 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?*

FacebookInstagramOnline AdvertisementGoogle SearchReferred by a friendNewspaper/MagazineOther
Any special instructions, comments, or suggestions?
By signing below, I agree to the terms and conditions of the salon company.
Client's Signature*
Date Signed

MonthDayYear
Date
Thank you for considering Moore By Beverly for your luxury hair care needs. Due to a high volume of requests response time is currently 2-3 weeks. Thank you for your patience.

We look forward to working with you!
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