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9
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1
What is your name?
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First Name
Last Name
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2
Email
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For communication purposes and appointment confirmations.
example@example.com
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3
Phone Number
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For text confirmations
Please enter a valid phone number.
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4
What is your mailing address?
For occasional promotional mailings.
Street Address
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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
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5
Would you like to share your birthday?
I'd love to send you a gift during your birth month!
-
Date
Year
Month
Day
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6
Why are you looking for a new stylist?
*
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I'm looking to cover grey and add dimension
I'm looking to find a dimensional lightening specialist
I need a more low maintenance color
I'm not 100% happy with my current stylist & need someone new.
I'm interested in adding fullness to my hair with extensions
I'm interested in adding length to my hair with extensions
I just moved to the area and am seeking a forever stylist
I'm ready to get on a regular maintenance schedule
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7
Have you received any chemical services in the last year?
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YES
NO
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8
If you answered "yes" to the previous question please tell me a little bit more about the services you've received.
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9
I use natural products in my salon that contain ingredients commonly found in our natural resources. Do you have any allergies I should be aware of? (dairy, nuts, soy, foods, certain chemicals, hair color, etc)
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10
Tell me a little about your hair goals:
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11
Do you need help creating a daily haircare routine for yourself?
YES
NO
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12
Please share an inspiration photo for your color or haircut:
This will help me have a better idea of what you're looking for.
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13
Here are some of my policies that must be agreed on before your first visit to the salon.
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SERVICE & RETAIL SATISFACTION POLICY: My goal is to use your photos as inspiration to give you a look of your own. If you are unhappy with your service, please contact Teresa immediately so that she can make an adjustment. Complimentary revisions must be within 7 days of the original service and within the scope of what was originally discussed. Remedy Salon & Wellness will not be liable for hair color or cuts done by someone else. CANCELLATION/NO SHOW POLICY If you are unable to keep your scheduled appointment time, please give 24 hour advance notice. I understand that sometimes emergencies happen and it is not possible to give notice so I do ask that you contact me as soon as possible in these situations. After more than one cancellation with less than 24 hour notice, a non-refundable fee of 50% of the originally scheduled service will be due before your next appointment. In the case of a no-show appointment, a $25 fee for EACH SERVICE scheduled or 50% of the scheduled appointment (whichever is greater) will be invoiced to you and due before another appointment can be made. After two (2) no call/no-show appointments, client will no longer be able to book future appointments with Remedy Salon & Wellness. This cancellation policy is subject to change at any time without notice. CHILDREN: I love meeting your new babies! Unfortunately, the salon is not a place for mobile little ones. Due to the use of chemicals, hot tools, and sharp objects in the salon, I kindly ask that only those receiving services be present in the salon due to limited space and the safety of all guests.
I agree
I do not agree and do not want to continue with services.
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