Client Intake Form

Client Intake Form

Due to limited availability and high demand for services, potential clients are required to fill out the client intake form below. Please allow up to 48 hours for a response via phone call or email. Be advised that some responses may land in your spam folder. NOTE: ALL SERVICES ARE RENDERED AT THE RANCHO CUCAMONGA LOCATION.
Ful Name:*

First NameLast Name
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Instagram Handle:*
Date of Birth:*

MonthDayYear
Date
Emergency Contact Name:*
Emergency Contact Number:*
Please enter a valid phone number.Format: (000) 000-0000.
How did you discover us?

InstgramFacebookGoogle adReferral
Referred by:
How would you describe the current condition of your natural hair?*

Healthy & HydratedDry & BrittleEasy & ManageableThick & Unruly
Length*

Above the shouldersBetween shoulder and bra strapBra strap or longer
Curl Pattern*

WavyCurlyCoilyNot sure
What is your “go-to” hairstyle?

Natural styling with no heat (bun/ponytail)Sew-In WeaveBraids, Twists, CrochetWigs, Hats, Turbans
Do your have any chemicals in your hair? (Relaxer, Keratin, Color, etc).*
Have you worn extensions before? *
Are you currently in extensions? If so, what type? If not, when was the last time you wore them?*
What are your reasons for wanting extensions?*

FullnessLengthColorProtection
When was the last time your hair was done by a professional in a salon?*
Are you aware of any allergies you may have?*
How often are you willing to come into the salon for hair services?*
Do you wear your hair pulled back in high or low ponytails?*
How often do you work out or exercise?*
Are you currently taking any type of medication?*
Do you perspire heavily in your hair, scalp or face?*
Do you have any hair/scalp conditions or concerns?*
What are your hair goals?
Please list any additional details or concerns that should be addressed during consultation appointment.
Please upload a current photo of your hair. (No full body images. Photo must show full length of your hair. No photo filters or effects)*

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Should be Empty: