New Client Intake Form

New Client Intake Form

I'm excited to have you as a new potential client. The health and integrity of your hair is most important to me as your hair care provider. Please fill out this form to help me better understand your hair needs and desires as well as some hair history. This will help us best navigate your hair journey together.
Date

MonthDayYear
Date
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Birthday

MonthDayYear
Date
How did you hear about me?
What services are you looking to schedule?

Hair CutRoot Color RefreshAll Over Color, Roots and EndsMaintenance Lightning ServicesAll-Over Refresh of Lightening ServicesMaintenance Highlight's with Root Color RefreshConditioning Treatment and/or Gloss RefreshColor CorrectionHair ExtensionsI'm Not Sure, Lets book a Consultation
How often do you like to maintain your hair services?
What days of the week are you available?

TuesdayWednesdayThursdayFriday
What time frames are you available?

9am- 12pm12pm- 4pm4pm- 8pm
How would you describe the current health of your hair?
Current Hair Length
Current Hair Density
Current Hair Texture (choose all that apply)

FineMediumCourseWaveyCurly
What do you currently love about your hair?
How would you describe your hair color right now?

Natural, I have never colored my hair.Natural with blonde highlights, Balayage.Colored, Colored all over, grey coverage.Grey coverage with new or grown out Highlights.I haven't had it colored in a long time.I color my hair at home.
What are your main concerns with your hair right now?
Have you ever had a hair professional use a technique or perform a service that ended poorly or did not meet your expectations?
When was your last hair appointment? What services did you have done?
Have you ever had any of the following services done professionally?

Chemically ColoredChemically LightenedChemically PermedChemically StraightenedChemically RelaxedNone
In the past 10 years have had professional services for, or self-applied any of the following?

Box ColorAny Hair Color or Templary hair Color NOT applied in a professional salon settingHenna or Metalic DieOrganic Hair color From a Natural Food Store
Do you currently have hair extensions installed?

YesNo
Do you have any allergies to hair color, products or scents?
Are you or have you been pregnant in the past 6 moths?

YesNo
Any specific needs or instructions I need to be made aware of prior to your hair appointment?
Any questions or concerns prior to booking?
Please submit any and all inspiration pictures your being drawn to.
Please submit any and all pictures of your current hair color for reference. Please avoid filters, obstructed or harsh angles, or non-natural lighting.
Your hair is an investment, and your budget is important! Please select all that apply for your budget per appointment.

$100 - $200$200 - $300$300 - $450$450+
By signing here, I am acknowledging that I have filed out the New Client Intake Form honestly and to the best of my knowledge. I am also agreeing to terms and conditions set forth by Moonshine Beauty SRQ LLC, including the Deposit and Cancellation policies. If a deposit is required for the services you wish to book. Your appointment will not be secured until the deposit is received.

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