NEW CLIENT REQUEST FORM
Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Method of Contact
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Text
Call
How did you hear about Urban Roots Beauty Studio?
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Client Hair Information
How would you describe the current condition of your hair? Please include details such as texture, damage, porosity, etc.
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Have you had any treatments or chemicals on you hair in the last 3 years? (excluding basic color & lightening) Example: Keratin Treatment, Brazilian Blowout, Relaxer or Perm, etc.
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Do you have or have you ever had any sensitivities, issues, or conditions with your scalp? If yes, please specify. Include timeline.
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Information Continued
Please describe your current hair style, color, cut, and a brief summary of current maintenance.
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How satisfied are you with your current hair look?
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Dissatisfied
1
2
3
4
Very Satisfied
5
1 is Dissatisfied , 5 is Very Satisfied
Please describe your hair density. (Thick, thin, fine, coarse)
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Are you currently on any medications that may affect your service process? If yes, please explain.
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Which service or services are you interested in booking?
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What is your ideal maintenance plan?
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10+ Weeks
8 Weeks
6 Weeks
4 Weeks
Please describe your usual hair care routine. (Washing, styling, products, etc.)
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Closing
If your service will require more than one session to complete, would you be willing & able to return in order to achieve your end-goal hair?
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Are you willing to invest in suggested products to help maintain your services as well as the integrity of the hair?
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I strongly enforce my late policy & cancellation policy. Is this something you will be understanding of?
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Yes
No
Do you have any questions/concerns? Do you have other information you would like to share in order to help me review this request?
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Submit
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