New Client Appointment Request Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Address
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
4
Phone Number* This field is required.
Please enter a valid phone number.
5
How did you hear about Daphne Wrung?
6
How long since your hair was last colored?* This field is required.
1-2 months ago
3 - 4 months ago
5 + months ago
I've never colored my hair
7
Are you ONLY looking to book a haircut?* This field is required.Daphne Wrung currently is not accepting any new "Haircut Only" guests. You must be getting a color done with your service in order to receive a haircut/appointment.
YESNO
8
Thank you for your interest in Daphne Wrung at Salon Exodus. At this time, Daphne is not accepting haircut only clients. Since you have selected a haircut only service, she would love to recommend you to the follow stylists who could accomodate your needs:

Melanie Hall - 206.818.7049
Eleni Yancy/Chanse - 206.434.7059
Kyle Johnson - 206.227.4381
Gerene Rogers - 360.621.4945
9
Check off all of the services you think you might need.* This field is required.
Grey Coverage
Balayage
Foil Highlights
All Over Lightning
All Over Darkening
Haircut
Clipper Cut
Color Correction
Shadow Root
Lowlights
Conditioning Treatment
Product Recommendations
Toner
Styling Lessons
Other
10
Please share a photo of your current hairTo take the most accurate photo, please photograph the back of the head in indirect, natural sunlight. Please refrain from using photos in direct sunlight, artificial light or in the dark.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
11
Please share a photo of your desired lookPlease understand that some photos may be altered or a filter is used. If this is the case, Daphne will happily go over realistic expectations.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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12
Image Field
13
Based upon Daphne's Service Menu, what Service Package are you thinking you may need?* This field is required.
Color Package $210+
Partial Custom Color $300+
Full Custom Color $355+
Color Shift Package $425+
Other
14
Hair Density Examples
15
Based upon the hair density examples, how would you describe your hair density/thickness?* This field is required.
Please Select
Please Select
Extra Light
Light
Light Medium
Medium
Medium Heavy
Heavy
Extra Heavy
16
Hair Length Chart
17
In the state that you wear it most often (Natural, Straightened, Smoothed, Curly etc.), How would you describe your hair length?* This field is required.
Please Select
Please Select
Short
Medium
Long
Extra Long
18
Your hair history within the last 3+ years.* This field is required.
I have colored my own hair.
I have not colored my hair in 3+ years
I have gotten my hair colored by a professional only.
Other
19
What hair color/product did you use? Please Check all that apply.
From Sally's Beauty Supply
From Online
From Drugstore/Grocery Store
Box Dye
Splat
Overtone
Temporary Hair Color Rinse
Other
20
Is there anything else you'd like to share?
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: