🌻 New Client Intake Form 🌻
Client's Name
First Name
Last Name
Client's Phone Number
Format: (000) 000-0000.
Client's Email Address
example@example.com
Occupation
Select a requested hair service
Adult shampoo, haircut & style
Toner/glaze
Hair color (base only)
Hair color (1 color all over)
Partial highlight
Full highlight
Base + balayage
Hair styling (Special Occasion)
Balayage and haircut
Other
What days & times work best for your hair appt?
Upload a hair inspiration photo ✨
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
Upload an image of your current hair
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
How often do you go to the salon for hair treatment?
Every 3-4 weeks
Every 2 months
Every 4 months
Twice a year
Once a year
Other
How long is your hair?
Short
Medium
Long
Other
What is the current condition of your hair?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
No issues
Other
What is the current condition of your scalp?
Dry
Normal
Oily
Other
How often are you washing your hair with shampoo + conditioner?
Every day
Every other day
Twice a week
Once a week
Other
Have you used the following in your hair before?
Permanent hair color
Keratin Treatment
Razor cut/Thinning
Relaxer
Henna
When was your last salon visit?
 -
Month
 -
Day
Year
Date
When did you last apply professional or unprofessional color in your hair?
Kindly list the hair products that you are currently using below:
What hot tools you are using to style your hair?
How did you hear about us?
Facebook
Instagram
Google Search
Referred by a friend
Other
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
 -
Month
 -
Day
Year
Date
Submit
Submit
Should be Empty: