New Client Pre-Visit Form

1
What's your first name?* This field is required.
2
What's your last name?* This field is required.
3
Phone Number* This field is required.By providing your cell phone number, you agree that Anita or a Salon Margrit team member may reach out to you regarding hair services.
Please enter a valid phone number.
4
Email* This field is required.Please be sure this is an email you check often, as this is how I will be reaching out to you! By providing your email address, you agree to receiving emails from LuxuryHair by Anita.
example@example.com
5
Address* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
6
Emergency Contact & Phone Number* This field is required.
7
Birthday* This field is required.
Date
Month
Day
Year
8
Nice to meet you, {whatsYour}!

I'm Anita, from LuxuryHair by Anita at Salon Margrit and I'm so excited you're here! I first want to thank you for taking a few moments to complete this New Client Pre-Visit consultation form.

The goal with this form is to get to know you and your hair goals, which will help me determine if you're a great fit for my specialized services. Completing this form will also help me be able to narrow down a price range for your specific goals and help answer some of your questions along the way.

Let's get started!
9
How did you hear about LuxuryHair by Anita* This field is required.
Google
Facebook
Instagram
Referral
Other
10
If referred, to whom should we thank?
11
Preferred Appointment Day* This field is required.
Monday (50% service increase)
Tuesday (50% service increase)
Wednesday
Thursday
Friday
Saturday (75% service increase)
No Preference
12
Preferred Appointment Time* This field is required.
Early Morning (before 10:00a.m. - 25% service increase)
Morning
Lunch Time
Late Afternoon
Evening (after 4:00p.m. - 25% service increase)
No Preference
13
How soon would you like to come in for an appointment?* This field is required.
This Week
Next Few Weeks
Next Month
Next Few Months
As Soon As Possible
14
Please select all options that would describe your hair.* This field is required.
Fine
Medium
Coarse
Thick
Thin
Dense Kinky/Coiled
Curly
Wavy
Oily
Dry
Limp
Dull
Damaged
Heavy
Sparse
Unruly
Frizzy
Straight
15
How long is your hair?* This field is required.
Pixie to chin length
Chin to shoulder length
Past shoulders to mid-back
Mid-back to low-back
16
Do you currently have any hair/scalp concerns?* This field is required.
Bald Spots
Thinning/Excessive Shedding
Scalp Irritation/Sensitivity
Flaking/Dry Spots
Breakage
None, my hair and scalp are generally healthy
17
Do you currently color your hair?* This field is required.
YESNO
18
Have you used any of the following on your hair in the past 3 years? (Box dye, Henna color, Sun-in, metallic dyes, vivids/fun colors, color deposit shampoo/conditioner, spray tints, etc* This field is required.
Yes
No
No/Not Sure
19
Do you have a sensitivity or allergy to the following permanent color ingredients?* This field is required.
Ammonia
PPD (paraphenylenediamine)
MEA (Monoethanolamine)
Not at all
Not sure, please perform a patch test ($25)
20
Color Strand & Patch TestIf your hair has been previously colored over the last 1-3 and you desire to drastically alter your existing color, a Strand Test will need to be conducted to determine how achievable your goals will be. A small portion of hair will be cut at the root in a discreet manner, and processed with a variety of color products to establish the outcome. If you are unsure of any color allergies/sensitivities, a Patch Test is a procedure used by Anita before applying color to the scalp. It is a simple and safe way of identifying whether the hair dye being used will cause an allergic reaction with the skin. A drop of color is typically applied to the back of the elbow, and behind the ear and left to dry. You must wait 48 hours prior to any chemical service to rule out a negative response. Both these tests should be done prior to scheduling any service, and can be conducted at your in person consultation. A fee of $25 will be applied for each test conducted.
I agree to have these done at my consultation, and the $25 fee per test, prior to receiving services.
I do not agree to these have these tests done, and will not continue with services
21
What you love about your hair currently?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
22
What do you dislike about your hair currently?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
23
Are you looking for a complete change or to maintain what you currently have?* This field is required.
Complete Change
Maintain
Somewhere in Between
Not sure
24
How frequently would you like to visit the salon for maintenance?* This field is required.
Every 4 - 8 Weeks
Every 8 -12 Weeks
Every 3 - 4 Months
Every 6 - 12 Months
25
Which New Client Service Package are you most interested in scheduling for your first visit?* This field is required.
01 - "Lived-In" Color ($700)
02 - Beachy Blonde ($650)
03 - Sunkissed Highlights ($400)
04 - Rooty Dimension ($500)
05 - Royal Rejuvenation ($375)
06 - Revitalize Me ($225)
26
Would you like to add a haircut to your color package?* This field is required.
Yes (+30 mins $130)
No, not at this time.
27
Would you like to add a Grey/Root Coverage to your color package?* This field is required.
Yes (+30 mins $130+)
No, not at this time.
28
What services are you most interested in receiving regularly after your first visit?* This field is required.
Extensions
Toppers
"Lived-in" Color
Blonding
Grey/Root Coverage
Single Process - root to end color
Haircuts
Keratin Smoothing Treatments
Healthy Hair & Scalp Treatments
Blow Dry Styling
29
{whatsYour}, WE'RE ALMOST THERE!

Follow the instructions below and show me some photos of your current hair AND some inspiration photos on the next steps.

These photos will help determine if you're a good applicant for my specialized services. This will save time for both you and I and help narrow down a price range for you.

Don't be nervous! I don't need to see your face, just your hair! Feel free to put an emoji over your face if you're not comfortable. This is solely to see your current hair.

Must be photos of your current hair.
Use your cell phone.
It's way easier if someone else takes the photo for you, but you can also set your timer and take a step back to ensure ALL of your hair is in the photo.
Take in natural lighting (no flashes, please).
You will take two-/three photos - Front, back, and side (side is optional but appreciated).
Alternatively, you may email your name and these photos to info@luxuryhairbyanita.com once you complete your application.
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Please upload 2 photos of your hair - front & back - Please don't use filters or bright direct sunlight. Natural Shaded light is best.Must be current photos of your hair. Please do not send old, inappropriate or photos not pertaining to hair goals.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Please upload up to 3 photos of your goal hair.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
32
Pre-Service Agreement* This field is required.I understand that this is a general consultation intake form designed so that Anita at Salon Margrit can help me choose which New Guest Service option that I'm best suited for (if not already booked), or to help Anita prepare for my first visit. I understand that if I desire a more thorough explanation of the coloring process, or a detailed analysis of my current hair, I will need to schedule an in-person consultation. I understand that by submitting this form it does not guarantee that my goal hair can be achieved in one session. This will be determined in person based on the amount of time booked, density/length of my hair, as well as my time and monetary budget. Please sign below and click the next button.
I agree
I disagree and do not wish to schedule
33
Salon Environment & Safety Policy* This field is required.Our clients safety and the environment we provide for our services is our top priority. We care about our clients and their families but unfortunately lack the space & capabilities to provide care for young children while you are being serviced. Children can not be left unattended in the reception area & guests of our clients will not be able to accompany them on the salon floor for the safety of our staff & our clients. In order to maintain the standard of our salon environment we ask that all cell phones should be placed on silent while receiving services. We ask that you please keep phone conversations to a minimum & be respectful of the clients around you. Speaker phone or audible sounds are not permitted in any area of the salon floor or shampoo area. If cellular communication is required, and our staff are unable to continue service, then appointments may be altered or rescheduled as necessary to respect the time of the fellow clients. Cancellation fees will be applied.
I agree
I disagree and do not wish to schedule
34
Service Re-Do & Retail Return Policy* This field is required.ALL SERVICE SALES ARE FINAL LuxuryHair by Anita and Salon Margrit strive to offer our clients the highest level of customer satisfaction and take our time to conduct a thorough consultation to communicate your desires and expectations ensuring a favorable service outcome. Should your outcome not match your expectations, please let us know within 7 days of your visit by calling 561-655-3430. We are happy to correct the concern(s) complimentary, within the limitations discussed during your original consultation with Anita, as there are NO REFUNDS on services. Adjustments that alter the original plan or are made more than 10 days after the original appointment, will require full payment. Should you make a retail purchase that you are unsatisfied with, we will accept retail exchanges at full store credit, 14 days from your initial purchase. Please select below if you agree to these terms and would like to continue with your services.
I Agree
I disagree and do not wish to schedule
35
Appointment Change/Reschedule/Cancellation Policy* This field is required.Your appointments are very important to LuxuryHair by Anita at Salon Margrit and are reserved just for you. Late cancellations or no shows dramatically impact Anita, Salon Margrit, and other clients that may have preferred to come in at your appointment time. To maintain committed scheduling from all our clients, we ask for a card to be kept on file and require 48 salon business hours via phone 561-655-3430, to change/reschedule/cancel appointments. Any appointment change/rescheduling/cancellation, including calling in sick, with less than a 48-hour notice will be required to pay 50% of the scheduled appointment’s menu price. Same day cancellations/no shows will be required to pay 100% of the scheduled service price and will be charged to the card on file at end of business day. If we do not have an up-to-date card on file, a $25 penalty fee will be applied to the service(s) total and must be paid in full before any future service can be scheduled with Anita. Clients who no-show on more than one occasion must pre-pay, in full, for any service(s) they would like to schedule. Additionally, if you arrive 15mins after your scheduled appointment time, you will be subject to a 25% late fee determined by the scheduled service. Anita has the right to refuse the service if the service time remaining cannot accommodate your lateness, and you will be required to pay in full before rescheduling your appointment to another day. Conversely, if I ever run more than 15mins late, or have to cancel last minute due to unforeseen circumstances, you will be given a courtesy call prior to your appointment to adjust, or reschedule your services. In addition, you will receive a complimentary conditioning treatment (valued up to $60) at your re-scheduled service, and 10% off your service(s) performed, valid for 30 days of the original scheduled appointment.
I agree
I disagree and do not wish to schedule
36
Anything else you want me to know?
Huge
Large
Normal
Small
Ok
Ok
37
Now knowing the financial and time commitment for your hair, are you ready to invest in making your dream hair a reality?* This field is required.
Yes, I can't wait!
No, I'm not ready at this time.
I want talk more about the service options.
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