Kim' Kloset Hello Gorgeous! Salon Information Form
Hello Gorgeous! You’re invited to enjoy a one-time pampering experience at Kim’s Kloset Salon in Mishawaka, Indiana. You can choose up to 2 salon services or a wig—it’s completely up to you! These special services are offered just for women who are currently battling cancer or are recent survivors. We’ve partnered with Hello Gorgeous! certified licensed cosmetology professionals to provide this experience just for you. Thanks to our amazing donors and fundraisers, everything is 100% free for you to enjoy!
Today's Date
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Month
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Day
Year
Name:
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Phone Number
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Format: (000) 000-0000.
Your Email
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Best time to call or text you?
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Address
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Street Address Line 2
City
State / Province
Postal / Zip Code
Please note: You are allowed to bring guests to your appointment. We ask if you have children under the age of 7 they are accompanied by additional adult
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I understand
How did you hear about Hello Gorgeous!
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Are you currently battling cancer?
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Yes
No
Are You Currently Undergoing Treatment?
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Yes
No
How long have you been a cancer survivor?
Are You Currently working?
Yes
No
If yes, are you working full time or part time?
Full Time
Part Time
Name of Employer
Type of Cancer
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
Please Note: If you have chosen a nail service or services. Please remove all gel polish before your appointment. We only offer natural nails services. Appointment type subject to change if you have gel or artificial nails.
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Yes
No
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. Please note we will do our but to find a great wig, however it is not guaranteed. ***Note if you are not able to upload a picture. Please email it to info@hellogorgeous.org put your name in the memo line. Some photos will be to large to upload***
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Current Clothing: Shirt size?
Current Pant size?
Current Dress 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?
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