Service Request Form with Emily Chen

Transformative Haircut w/Emily

Intake form
Full Name*

First NameLast Name
Contact Number*
Please enter a valid phone number.
Email Address*
example@example.com
The following criteria must be met in order to be considered for a transformative haircut service with Emily:
Brooks & Harlow Salon is located in Victor, NY just outside of Rochester. Are you willing to travel to our salon for your transformative haircut service?*

Yes I am
During your service, are you comfortable with your hair and face on camera for the purpose of use on Emily’s social media?*

Yes I am
Please provide at least one photo of your current hair:
Photo from the front:*

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Photo from the back:

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Additional photo (optional) :

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Additional photo (optional) :

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Please provide at least one goal photo:

Upload your goal photos here, and in the space below, please describe what you're looking to achieve.
1st Goal photo:*

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2nd Goal photo:

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3rd Goal photo (optional):

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What do you like about the goal photos you've submitted? What are you trying to achieve? Go into as much detail as you'd like:*
Thank you for your interest in scheduling a service with Emily.

Please note that your submission will be ineligible for consideration if any of the information requested in this form is not included.

If you have any specific questions that have not been answered in this form, please reach out to our reservations team during business hours at (585)398-8045 and we will be happy to assist you!
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Transformative Haircut w/Emily

The following criteria must be met in order to be considered for a transformative haircut service with Emily:

Please provide at least one photo of your current hair:

Please provide at least one goal photo: