Kim' Kloset Hello Gorgeous! Salon Information Form
Restoring the beauty that cancer steals! Pampering women battling cancer, & recent survivors in our Hello Gorgeous! certified salon with licensed cosmetology professionals. Ladies, you will be able to choose 2 safe salon services that are complimentary to you because of donations, sponsors, and fundraisers!
Date
*
-
Month
-
Day
Year
Are you currently battling cancer?
*
Yes
No
How long have you been a cancer survivor?
Name:
*
Phone Number
*
Best time to call or text you?
*
Your Email
*
Address
*
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Cancer
Are You Currently Undergoing Treatment?
*
Yes
No
If checked yes, what treatments are you undergoing at this time?
Please Choose 2 complimentary services you would like to enjoy during your appointment at Kim's Kloset Salon.
Wig fitting and styling
Haircut and Style
Manicure
Pedicure
Facial
Makeup Tutorial and Application
If you would like a wig, please upload a photo of you when you loved your hair or a picture of the type/ style of wig you would like to get.
Clothing: Shirt size?
Pant size?
Dress Size?
Shoe size?
Petite, Average, or Tall clothing sizes?
Do you like pastel clothing or vibrant colors?
Jewelry: Simple or Bold and Chunky
Jewelry
Earrings
Necklaces
Bracelets
Jewelry: Silver or Gold?
What kind of music do you like?
Submit
Should be Empty: