Hair Salon Client Intake Form
Client's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Client's Phone Number
Format: (000) 000-0000.
Client's Email Address
example@example.com
Select a hair service
Adult Hair Cut
Cut & Shampoo
Hair color (Permanent)
Hair color (Semi)
Hair Conditioning Treatment
Highlights
Hair Extensions
Hair Toning
Facial Waxing
Professional Hair Care Products
What are you looking to achieve at your appointment?
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 treatment?
Every week
Every 2 weeks
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 use the following in your hair before?
Permanent hair color
Keratin Treatment
Razor cut/Thinning
Relaxer
Henna
Hair Extensions
Retinol
Chemical Peels/Facials
Box Color of any kind
Perms
Scalp Treatment
When did you last visit a hair salon?
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Month
-
Day
Year
Date
When did you last apply professional or unprofessional color in your hair?
Are you taking any medications that could alter the desired outcome of your hair? 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?
Facebook
Instagram
Google Search
Referred by a friend
Yelp
Other
Any special instructions, comments, or suggestions?
By signing below, I agree to the terms and conditions of the salon company.
Client's Signature
Date Signed
-
Month
-
Day
Year
Date
Hair Love By Samantha LLC
Print Form
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