Hair Salon Client Intake Form

Hair Salon Client Intake Form
Client's Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
Client's Phone Number*
Client's Email Address
example@example.com
Occupation
Select a hair service*

Adult Hair CutCut & ShampooHair color (Permanent)Hair Care TreatmentHair Color BlendingHair ConditioningHair styling (Formal)Sew InTree BraidsRelaxersKnotless BraidsHighlightsCrochet BraidsWig InstallRetwistSilk PressSleek PonytailOther
What hair style do you like?
Upload an image of a hair style or hair color done by me you prefer

You can upload multiple files here
Cancelof
Upload an image of your current natural hair*

You can upload multiple files here
Cancelof
How often do you go to salon for hair treatment?*

Every weekEvery 2 weeksEvery 3-4 weeksEvery 2 monthsEvery 2-6 monthsTwice a yearOnce a yearOther
How long is your hair?*

ShortMediumLongOther
What is the current condition of your hair?*

Hair lossDamage due to heatSplit endsBreakageItchy scalpHair is dryDandruffHair thinningThinning hair edgesOther
What is the condition of your scalp?

DryNormalOilyOther
How often do you apply shampoo and conditioner in your hair?

Every dayEvery other dayTwice a weekOnce a weekOther
Have you use the following in your hair before?*

Permanent hair colorKeratin TreatmentRazor cut/ThinningRelaxerHennaNone
When did you last visit a hair salon?

MonthDayYear
Date
When did you last apply professional or unprofessional color in your hair?*
Are you taking any medications? If yes, please list them below:*
Kindly list the hair products that you are using*
What are the tools you are using to style your hair?
How did you hear about us?*

FacebookTwitterInstagramYouTubeOnline AdvertisementGoogle SearchNewspaper/MagazineOther
Any special instructions, comments, or suggestions?*
Today's Date *

MonthDayYear
Date
Should be Empty: