New Client Consultation Form
Southern Roots Hair Design
Name
First Name
Last Name
Phone Number
Format: (000) 000-0000.
Email
example@example.com
Birthday
-
Month
-
Day
Year
Date
Select a salon service
Hair Color
Curly Cut
Cut/ Shape
Highlights
Trim
Twist- Out
Two- Strand Twists
Wash & Go
Nail Polish
Nail Care
Make-up
Iron/Curling
Shampoo & Blowdry
Straightening and Perming
Waxing
Treatments
Other
Select your appointment day and time
What hair style do you like?
Upload an image of the hair style you prefer
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
Any special instructions?
How often do you go to salon?
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
How often do you apply shampoo in your hair?
Every day
Every other day
Twice a week
Once a week
Kindly describe the status of your scalp.
Dry
Normal
Oily
Other
Describe your hair by checking the options below: (You can select more than one)
Healthy
Damaged
Straight
Wavy Curly
Fine
Thick
Other
When did you last apply professional or unprofessional color in your hair?
Do you have any hair loss problems in the past?
Are you currently taking any medications? If yes, please list them below. If not, please put N/A.
Please indicate the list of hair products you're currently using:
How did you hear about this salon?
Facebook
Twitter
Instagram
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Other
Client Signature
Date Signed
-
Month
-
Day
Year
Date
Print Form
Submit
Submit
Should be Empty: