New Client Intake Form
Client's Name
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Client's Phone Number
Format: (000) 000-0000.
Client's Email Address
example@example.com
Occupation
Select a hair service
Hair Cut
Gloss / Tone
Highlights
Extensions
Balayage
Grey Coverage
What hair style do you like?
Upload an image of hair style or hair color you prefer
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
Upload an image of your current hair
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
How often do you go to salon for hair service?
Every 3-4 weeks
Every 2 months
Every 2-6 months
Twice a year
Once a year
Other
How long is your hair?
Short
Medium
Long
Other
What is the current condition of your hair?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Other
What is the condition of your scalp?
Dry
Normal
Oily
Other
How often do you apply shampoo and conditioner in your hair?
Every day
Every other day
Twice a week
Once a week
Other
Have you used the following in your hair before?
Permanent hair color
Keratin Treatment
Relaxer
Henna
Box Dye
When did you last visit a hair salon?
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Month
-
Day
Year
Date
Last 3 years hair color history? And when did 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 me?
Instagram
Referred by a friend
Tiktok
Other
By signing below, I agree to the terms and conditions.
Client's Signature
Date Signed
-
Month
-
Day
Year
Date
Print Form
Submit
Submit
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