Hair Salon Client Intake Form
Client's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Client's Phone Number
Client's Email Address
example@example.com
Occupation
Select a hair service
Adult Hair Cut
Cut & Shampoo
Hair color (Permanent)
Hair color (Semi)
Hair Color Blending
Hair Conditioning
Hair styling (Formal)
Hair styling (Special Occasion)
Perms
Relaxers
Retexturizing
Highlights
Make Up
Nail Care
What are your mane goals?
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
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
How often do you go to a salon?
Every week
Every 4-6 weeks
Every 6-8 weeks
Every 3-6 months
Twice a year
Once a year
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 wash your hair?
Everyday
1-2 a week
Every other day
2-3 a week
3-5 a week
Other
When did you last visit a hair salon?
-
Month
-
Day
Year
Date
When did you 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 us?
Facebook
Twitter
Instagram
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
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
Submit
Submit
How often do you wash your hair?
Every day
Every other day
Once a week
Twice a week
Other
How much time do you spend styling your hair
0 to 10 mins
15-20 mins
30m-1hr
1+ hr
Should be Empty: