New Client Inquiry for Healthier Hair & Scalp Care Journey

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Please enter a valid phone number.
4
What serves you? * This field is required.
I want a physical appointment Virtual journey only
5
What’s suitable?
Hair Stylist traveling to you
You traveling to Nyce N Chic
Neither
6
Lifestyle & EnvironmentWhat best describes your environment or lifestyle?
Mostly indoors
Active lifestyle, frequent washing/sweating
Sunny climate, lots of UV exposure
Humid or dry climate extremes
7
Styling preferences What’s most important in your daily routine?
Low-maintenance, quick & easy
Defined styles with control
Natural/air-dry look
High-shine, polished finish
8
How would you describe the current state of your hair?* This field is required.
Naturally curly
Relaxed or permed
Natural silk press
Colored or bleached of any kind
9
Upload a photo of your hair in its natural state.* This field is required.
10
what hair service are you interested in?* This field is required.
Please Select
Please Select
Luxury Silk Press
Shampoo & blowout
Hair Growth & Scalp Care Program
11
Have you ever had a Silk press?* This field is required.
YESNO
12
What is the length of your natural hair?* This field is required.
Short (earlobe, chin or above shoulder length)
Medium (on or at the shoulders)
Medium to long (below shoulders to bra length)
Long to extra long (lower back to hip length)
13
What density is your hair?* This field is required.
Fine/thin
Medium
Coarse/thick
Fine & medium
Medium & coarse
14
What is your natural curl pattern?* This field is required.
Straight 1A-1C
Wavy 2A-2C
Curly 3A-3C
Kinky curly 4A-4B
Coily-kinky straight 4C
15
What condition is your hair currently?* This field is required.
Healthy (no split ends, no damage)
Thinning/shedding
Heat damage
Hair loss
Breakage of any kind
Dry/itchy scalp
Brittle/hard/dry hair
Scalp build up/skin sensitivity
16
Include specific results you’d like to seeCheck all that apply
Curl definition
Moisturized hair
Stronger hair
Thicker hair
Longer hair
Improved scalp
Glossy hair (no heaviness)
Smooth hair (fight frizz)
17
Please share anything else you’d like us to know or see differently with your hair?* This field is required.
Huge
Large
Normal
Small
Ok
Ok
18
Do you agree to follow Nyce N’ Chic recommended use of hair and skin care regimen/ or products for best results?
YESNO
19
Are you currently on any medications? (If yes, please list)
20
Upload a photo of inspiration or your desired look.
21
What date are you looking to have your first appointment?* This field is required.(All date requests are not official until approved)
22
Signature* This field is required.
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