Client's Name
First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Client's Phone Number
Client's Email Address
example@example.com
Select a hair service you're interested in getting
Blonding
Dimensional Coloring
Handtied Extensions
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Upload an image of your current hair
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Describe Current Color and Condition of Your Hair:
How often do you go to salon for hair treatment?
Every week
Every 2 weeks
Every 3-4 weeks
Every 2 months
Every 2-6 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
Other
How often do you apply shampoo and conditioner in your hair?
Every day
Every other day
Twice a week
Once a week
Other
Have you use the following in your hair before?
Permanent Color
Keratin Treatment
Chemical Relaxers
When did you last visit a hair salon?
-
Month
-
Day
Year
Date
When did you last apply professional or unprofessional color in your hair?
How did you hear about us?
Facebook
Instagram
Online Advertisement
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
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Month
-
Day
Year
Date
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