Kim' Kloset Hello Gorgeous! Salon Information Form
Restoring the beauty that cancer steals! This is a 1 time experience at the Kim’s Kloset Salon in Mishawka Indiana (limited to 2 hours max). Our safe salon services are for women battling cancer, & recent cancer survivors in our Hello Gorgeous! certified salon with licensed cosmetology professionals who have been Hello Gorgeous! certified. Ladies, you will be able to choose 2 safe salon services that are complimentary to you because of donations, sponsors, and fundraisers!
Today's Date
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Month
-
Day
Year
Are you currently battling cancer?
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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
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
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
Do you have artificial nails? Please note we are only allowed to offer natural manicures, and pedicures during our services. We are not able to offer any artificial or gel services
*
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.
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?
Submit
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