Rachel Samardjian Hair Artistry Intake Form
Name
*
First Name
Last Name
Date of birth
*
-
Year
-
Month
Day
Date
Email
*
example@example.com
What is your Instagram handle? (If applicable)
Phone Number
-
Area Code
Phone Number
How did you hear about me?
Instagram
Facebook
Friend/Family Referral
Google
Yelp
If Friend/Family Referral name drop below! (I have goodies for your friend!)
Are you an established or new client of Rachel's?
*
I'm Established!
New (Yay)
I'm interested in...
*
Color/Cut
Color only
Cut only
Extensions
The works! (Color, Cut, Extenisions)
I'm not sure, I need guidance!
How often do you like to maintain your cut/color?
4-6 weeks
6-8 weeks
3 months
6 months
Once a year
What is your availability for hair appointments?
Tell me about the current state of your hair (do you have extensions etc.)
What are your current go to haircare products?
*
What is your current hair color?
*
Black
Brunette
Blonde (Golden/Honey)
Red
Gray
Platinum/Silver
Black and I cover gray
Brunette and I cover gray
Blonde and I cover gray
What is your natural hair type?
*
Straight + thick
Straight + fine
Wavy + thick
Wavy + fine
Curly +thick
Curly + fine
How do you often wear/style your hair?
*
Flat Iron (Straight)
Flat Iron (Curly)
Blowout
Curling Iron
Braids
Bun/Ponytail
Messy Curls
What is your hair texture like?
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Fine
Medium
Thick
Coarse
Which of the following are your main hair concerns?
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Frizz
Breakage
Dandruff
Eczema/Psoriasis
General Hair Loss/Thinning
Bald Spots
Alopecia
COVID related hair loss
Chemical Breakage
Do you use chemical treatment or hair color at home?
*
Yes
No
Do you have any known allergies? Specifically to common ingredients found in hair and skin care lines. List known allergies below
*
What is your current hair length?
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Pixie
Short (and sweet)
Shoulder Length
Long hair don't care!
Very Long
When was your last haircut? (No one's judging)
*
What is your normal routine after washing your hair?
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Air/Towel Dry
Blow Dry
Diffuse
How often do you apply heat styling tools?
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Occasionally (1x a week)
Rarely (1x a month)
I love my irons! (4-6x a week)
On average, how often you you wash your hair?
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Once a week
Twice a week
Every other day (3-4x a week)
Daily
Once a month
Every other week
Let's talk about your ends...
*
I'm a hair model
Healthy for the most part, some split ends
Brittle and dry/lots of split ends.
Breakage everywhere
How about your scalp?
*
Normal
Dry
Very Dry
Oily
Very Oily
Psoriasis/Eczema
Describe your dream hair to me:
If you could change one or two things about your hair, what would they be?
*
Anything else you think I should know?
What is your preferred method of communication?
*
Text/Voice Message
DM on IG
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