Hair Salon Client Intake Form
Name
First Name
Last Name
Client’s Phone Number
Format: (000) 000-0000.
Client's Email Address
example@example.com
Date of Birth
-
Month
-
Day
Year
Which service are you looking to receive?
Highlights/Lowlights
Balayage
Root retouch
All over color
Toner/Gloss
Brazillian Blowout
Transformation cut
Other
If you chose other, please describe
Upload inspiration photo *Required for color or transformation cut*
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
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
When did you last visit a hair salon?
-
Month
-
Day
Year
Rough estimate is okay if unsure
How often do you get your hair done at the salon?
Regularly: Every few weeks
Every 2-6 months
Twice a year
Once a year
Rarely
Other
How long is your hair?
Short
Medium
Long
How often do you wash your hair?
Every day
Every other day
Twice a week
Once a week
Other
Have you use the following in your hair before?
Permanent hair color
Keratin Treatment
Box Dye
Relaxer
Henna
Perm
Other
Are you currently experiencing any hair troubles?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
No hair issues!
Other
How did you hear about us?
Instagram
Facebook
Tiktok
Other social media
Google Search
Referred by a friend
Newspaper/Magazine
Other
Name of reference (if referred)
Any special instructions, comments, or suggestions?
By signing below, I confirm that all information indicated in this form is true and accurate.
Client's Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Submit
Should be Empty: