Client Questionnaire
Thank you in advance for filling this out thoroughly and honestly. Because I value your time and money, this consultation application will help us determine if we are a compatible fit to help you achieve your hair goals.
Name
*
First Name
Last Name
Date of Birth
*
MM/DD/YYYY
Pronouns
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Phone Number
*
-
Area Code
Phone Number
Email
*
example@example.com
How did you hear about me?
*
Social Media (Instagram, Facebook, etc)
Online Search
Referral
Other
If referral, please list name:
What's your Instagram?
This isn't necessary, but we'd love to get feel for you, your lifestyle and what your lived-in hair looks like. Plus, we'd love to follow you! Find us on Instagram as @GoldStudioExperience
Medical History
Please list any known allergies:
*
If none, please write "None."
Please list any current medications:
*
If none, please write "None."
Are you pregnant or taking prenatal vitamins?
*
Yes
No
Have you ever experienced sensitivity to lightener?
*
Yes
No
If yes, please explain:
Have you ever experienced hair loss, thinning, breakage or bald spots?
*
Yes
No
If yes, please explain:
Your Hair Profile
What are your hair goals?
*
Examples: Color, cut, length, texture, maintenance, etc.
Please upload an example of what you have in mind:
What do you like about this photo? Do you dislike anything?
What does your hair currently look like?
What are your hair care challenges?
*
No volume
Too thick
Too thin
Dryness
Oily
Dull
Breakage
Frizziness
Won't stay curled
Curl management
No challenges
Other
What are you trying to achieve with your style?
Volume
More curls
Less curves
Straight
Other
What do you wish your hair did more of?
Preferred average visits to the salon:
*
Every 2-4 weeks
Every 6-8 weeks
Every 2-3 months
Every 4-6 months
Once a year
How much time do you spend styling your hair after you wash it?
Less than 15 minutes
Up to 30 minutes
Up to 45 minutes
More than 1 hour
What is your home styling comfort level?
Very comfortable
Comfortable
Uncomfortable
I want some tips!
What kind of styling tools are you using at home?
*
Flat iron
Curling iron
Blowdryer
None
Other
Current Products
Shampoos & Conditioners:
*
Styling Products:
*
Heat Protectants:
*
Other:
Hair History
Please provide a detailed description of your hair history for the last 3 years, including color, chemicals, bleach, treatments, etc:
*
Have you ever used box color?
*
Never
Less than 90 days ago
3-6 months ago
6-12 months ago
12+ months ago
Have you ever used henna color?
*
Never
Less than 3 months ago
3-6 months ago
6-12 months ago
12+ months ago
Have you ever received a chemical straighter, relaxer service or similar treatment?
*
Yes, within the last month
Yes, within the last 6-12 months
No
Please go into more detail about any questions you may have for your stylist:
I understand that chemical services can result in hair damage such as breakage, color alteration and/or permanent change of texture. I agree to hold the salon and the hair technician harmless in the event of unexpected or undesired results. I understand that any further alterations or corrections will be provided at my own expense.
*
I agree to these statements.
I understand that chemicals can damage my jewelry, clothes and/or accessories and I will dress accordingly for my appointment. I understand that the salon and the hair technician is not liable for any accidental damages.
*
I agree to these statements.
I understand, have read and completed this questionnaire truthfully. I understand that previous treatments and/or chemical services can affect the outcome of my desired results. I have fully disclosed all requested information related to my hair history. I understand that withholding information or providing misinformation may result in contradictions and/or irritation to the hair service being received.
*
I agree to these statements.
Signature
*
Submit
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