Client Request Form

New Client Request Form

Hello! I'd love to know a little more about you to help you with your hair. Please complete the form and then I'll be in touch soon!
Name*

First NameLast Name
Email address:*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Name on Facebook if you would like to connect:
Instagram Handle if you would like to connect:
How did you hear about me?*
Please upload a current picture of your hair:*

Cancelof
What Is Your Hair Type?*

StraightCurlyWavyCoiled
What Is Your Hair Density?*

Thin/FineMediumThick
Is Your Hair Color Treated?*

YesNo
Is Your Scalp...*

OilyDryNormal
How Often Do You Wash?*

Every dayEvery other dayEvery 3-4 daysOnce a week
Is Dandruff or Flakiness an Issue?*

YesNo
My Hair Is... (select all that apply).*

DryLimpFrizzyBrittle (breaks easy)Damaged From HeatThinningReceding (receding hairline)Has Split EndsChemically Over-ProcessedNone of the aboveOther
How Often Do You Apply Heat?*

NeverOnce in a while2-3 times a weekDaily
How Do You Prefer To Style Your Hair?*

Air-dried and StyledBlow-dried and StyledOnly Air-driedOnly Blow-driedOther
What Products Do You Use to Wash Your Hair?*
What Products Do You Use to Style Your Hair?*
What is Your Biggest Hair Concern?*
What Are Your Ultimate Hair Goals?*
Any Allergies to Chemical Services Or Products? If Yes Please Explain.*
What are the best days and times to schedule an appointment? *
Any other questions or concerns?
Please sign below confirming that all of the above information has been answered to the best of your knowledge.*
Kat Roy

Follow Me on Instagram or Facebook: @HairLoveByKat | E-mail: HairLoveByKat@Gmail.com
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New Client Request Form

Kat Roy