New Client Intake Form
Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
*
Email Address
*
example@example.com
Occupation
Select service(s) you're interested in:
Hair Cut
Hair Color (Permanent)
Hair Color (Vivids)
Color Correction
Partial Highlight
Full Highlight
Balayage
Bang Trims
Other
What words would you use to describe your style?
Upload an image of your dream hair
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
Upload an image of your current hair
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
How often do you go to the salon?
Every 3-4 weeks
Every 2 months
Every 3-4 months
Twice a year
Once a year
Other
How long is your hair?
Short
Medium
Long
What is the current condition of your hair?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Pretty alright
Other
What is the condition of your scalp?
Dry
Oily
Normal
Other
How often do you apply shampoo and conditioner to your hair?
Every day
Every other day
Twice a week
Once a week
Other
Have you used the following in your hair before?
Permanent hair color
Keratin Treatment
Razor cut/Thinning
Relaxer
Henna
Other
When did you last visit a hair salon?
-
Month
-
Day
Year
Date
When did you last apply professional or at-home color in your hair?
How did you hear about us?
Facebook
Twitter
Instagram
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Other
Any special instructions, comments, or suggestions? Did anyone refer you to Marquee?
By signing below, I agree to the terms and conditions of the salon company.
Client's Signature
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