MV Hair Salon Client Intake Form

Hair Salon Client Intake Form
Client's Name

First NameLast Name
Client's Phone Number
Client's Email Address
example@example.com
Birth Date (Month-Day)
Occupation
What hair services are you interested in?
Upload an inspiration photo of the hair style or hair color you want as the desired outcome.

You can upload multiple files here
Cancelof
Upload an image of your current hair preferably less than a month old.

You can upload multiple files here
Cancelof
Please provide a history of the last professional or store bought color applied to your hair, going back about 2-3 years.
How often do you visit the salon for hair services?

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

ShortMediumLongOther
What is the current condition of your hair?

Hair lossDamage due to heatSplit endsBreakageItchy scalpHair is dryDandruffOther
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 used the following in your hair before?

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

MonthDayYear
Date
Are you taking any medications? If yes, please list them below:
Kindly list the hair products that you are currently using
What are the tools you are using to style your hair?
How did you hear about us?

FacebookInstagramNextDoorGoogle Page SearchReferred by a friendOnline AdvertisementYouTubeOther
Please provide your ideal appointment time and availablity to best accommodate your schedule.
A credit card on file is required to secure your appointment. Any cancellation made less than 24 hours will result in a 50% service charge billed to your credit card. Do you agree? Yes-No
By signing below, I agree to the terms and conditions of my salon polices.
Client's Signature

Powered by Jotform SignClear
Date Signed

MonthDayYear
Date
Should be Empty: