New Guest Intake Form
Name
First Name
Last Name
Date of Birth
/
Month
/
Day
Year
Date
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation
What is your typical availability? Please select all that apply
Mid-morning
Afternoon
Evening
Tuesday
Wednesday
Thursday
Friday
Please select desired service(s) Cuts
Women's Cut & Style
Men's Cut & Style
Bang Trim
Beard Trim
Styling
Blow-Out
Blow-out W/Iron Work
Formal Style
Waxing
Brow Wax
Lip Wax
Chin Wax
Ear Wax
Custom Color (includes blow-out) Please note: custom color includes the spectrum of highlights/lowlights, balayage/foilayage, and lived in color
Face Frame Custom Color
Partial Custom Color
Full Custom Color
The Pearl Effect (grey blending)
Single Process Color
Base Color (root touch up)
All Over Color
Maintenance Gloss
Express Gloss
Smoothing Treatments
Keratin Express
Keratin Treatment
Liscio Straightening Treatment
Extensions
Tape Ins
Treatments
Solu Salt Scrub
Davines Masks
Malibu Detox
Scalp Ritual
Please upload an inspirational pic and briefly describe the look you are going for.
Upload an image of hair style or hair color you prefer
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Upload an image of your current hair
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How often do you visit the salon for color services?
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?
Pixie
Medium
Short
Long
Other
What is the density of your hair? Select all that apply
Thin
Thick
Medium
Coarse
Other
What is the current condition of your hair? Select all that apply
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 in the past 5 years?
Permanent hair color
Keratin treatment
Relaxer
Henna
At home color or box dye
Coloring conditioner
When did you last visit a hair salon?
-
Month
-
Day
Year
Date
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?
Facebook
Instagram
Google Search
Referred by a friend
Other
By signing below, I agree to the terms and conditions of the salon company.
Client's Signature
Date Signed
-
Month
-
Day
Year
Date
Thank you
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Submit
Submit
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