New Client Intake Form

New Client Intake Form

Please allow 48 hours for a response
Client's Name*

First NameLast Name
Date of Birth

MonthDayYear
Date
Client's Phone Number*
Client's Email Address*
example@example.com
Select a hair service that best describes what you're interested in.

Full HighlightColor RetouchPartial BalayageLowlightHalo FoilWomen's Hair CutFull BalayageColor Retouch + HighlightPartial BalayageHighlight + LowlightGlossAll Over ColorUnsure? Let's talk about it!
Please tell me more about what services you're interested in as well as the current state of you hair!*
Upload an image of hair style or hair color you prefer*

You can upload multiple files here
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Upload an image of your current hair*

You can upload multiple files here
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How long is your hair?

ShortMediumLong
What is the current condition of your hair? Select all that apply.

Hair lossDamage due to heatSplit endsBreakageItchy scalpHair is dryDandruffOther
What is the condition of your scalp?

DryNormalOilyOther
How often do you apply shampoo and conditioner in your hair?

Every dayEvery other dayTwice a weekOnce a weekOther
Have you use the following in your hair before?*

Permanent hair colorKeratin TreatmentRazor cut/ThinningRelaxerHennaNone
If yes please state when was the last time this service was done.*
When did you last visit a hair salon?

MonthDayYear
Date
When did you last apply professional or unprofessional color in your hair?*
Are you taking any medications? If yes, please list them below:
How did you hear about us?*

FacebookTwitterInstagramYouTubeOnline AdvertisementGoogle SearchReferred by a friendNewspaper/MagazineOther
By signing below, I agree to the terms and conditions of the salon company.
Client's Signature

Clear
Date Signed

MonthDayYear
Date
Should be Empty: