New Client Intake Form
Client's Name
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Client's Phone Number
Format: (000) 000-0000.
Client's Email Address
example@example.com
Occupation
Select the service you would like to inquire about.
Custom Extension Consultation
Custom Color Consultation
What struggles or dislikes do you have with your current hair?
What do you like about your current hair?
Describe your dream hair.
Upload an image of your hair inspiration
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
Upload an image of your current hair in indirect natural lighting
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
How often do you receive hair/beauty 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?
Short
Medium
Long
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 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 before?
Permanent hair color
Keratin Treatment
Razor cut/Thinning
Relaxer
Henna
When did you last visit a hair salon?
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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:
Please list the hair products that you are using.
What are the tools you are using to style your hair?
How did you hear about me?
*
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
Print Form
Submit
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