MOSAIC Appointment Request Form

Guest Welcome Form
Client Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
What services are you interested?

Full Color Change/UpdateMaintenance FoilsRoot Color Maintenance (not for foils)Custom Cut LongCustom Cut ShortCustom Cut Curly
Inspiration Photos

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Have you ever colored your hair?
If Yes, how was it done?

SALON PROFFESIONALI did it myself
How long ago?
Have you ever bleached/lightened your hair?
If Yes, how was it done?

SALON PROFFESIONALI did it myself
How long ago?
Have you ever had fashion colors in your hair? Ex. Purple, Blue, Green, Etc.*
If Yes, how was it done?

SALON PROFFESIONALI did it myself
How long ago?
Have you ever had any chemical services that aren't color? Ex. Perm, Relaxer, Japanese Straightening, Henna *
If Yes, how was it done?

SALON PROFFESIONALI did it myself
How dense is your hair?

FineMedium/ ThickThick/CourseCurly/ Textured
How long ago?
Scalp Health
Hair Health
What day/times work best for your schedule?*

MonTuesThurFriOther
What day/times work best for your schedule?*

Early MorningLunchtimeLate AfternoonEveningOther
More Information
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Guest Welcome Form