Client Intake Form
We Pay Your Deposit!!
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Health and Safety
Please select all of the following that apply to your current health and well-being
*
Allergies
Pregnant
Skin,Scalp, or Eye Conditions
Currently taking any Medications
Had a hair, facial, brow, lash, or nail service in the last 2 weeks?
I wear contact lenses
None of the above
Please explain in detail any of the above health and well-being concerns checked above, including but not limited to listing all applicable procedures, treatments, and medications below:
*
Services
Who would you like to be your Service Provider?
*
Choose the services you would like to receive:
*
Hair Services
Eyebrows
Eyelashes
Nails
Facial
Massage
Makeup
Other
Other
Proposed Budget for Service(s)
*
Preferred Date of Service
*
-
Month
-
Day
Year
Date
Second Choice Date of Service
*
-
Month
-
Day
Year
Date
Range of Dates for Availability
Hair Services
What hair services are you getting? (check all that apply)
Cut
Color
Highlight/Balayage
Styling (wash/blowout)
Keratin/straightening
Texture service (perm/c waves)
Other
Other
Hair goals in simple terms (e.g., want softer waves, darkercolor, more volume):
Hair type (check one):
Straight
Wavy
Curly
Coily
Other
Other
Natural hair concerns to address during service:
Do you have a preferred length or style after cut?
Any sensitivities to dyes or fragrances? (yes/no; if yes, explain)
Please upload inspirational photos:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Makeup
Skin type (check one):
Normal
Oily
Dry
Combination
Other
Other
Skin concerns you want addressed (acne, redness, dark circles, wrinkles, none):
Foundation shade or level (light, medium, dark; undertone if known):
Natural look or full glam? (natural/full glam)
Any colors you don’t want or need (lip, eye shadow, blush):
Please upload inspirational photos:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Facial
Facial goals (clearing pores, anti-aging, hydrates, soothing, etc.):
Any allergies to products (fragrances, essential oils, specific ingredients)? (yes/no; explain)
Do you prefer fragrance-free products? (yes/no)
Yes
No
Any sensitivities to heat or steam? (yes/no)
Yes
No
Last facial date (approximate):
-
Month
-
Day
Year
Date
Please upload inspirational photos:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Eyebrows
Brow shape you want (soft arch, strong arch, straight, natural, glam):
Brow color preference (match hair, lighter, darker):
Do you tweeze, wax, or thread, or both? (check all that apply):
Tweeze
Wax
Thread
Other
Other
Any shading, tint, or lamination requested (yes/no; explain):
Please upload inspirational photos:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Eyelashes
Lash services requested (check all that apply):
Lash lift
Lash tint
Extensions
Lash clean-up
Other
Other
If extensions, length/volume preference (natural, medium, dramatic):
Any allergies to adhesives or lash products? (yes/no; explain):
Do you wear contact lenses? (yes/no)
Yes
No
Please upload inspirational photos:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Nails
Service type (manicure, pedicure, both):
Manicure
Pedicure
Both
Nail health concerns (brittle nails, splitting, discoloration):
Brittle
Splitting
Discoloration
Other
Other
Nail length/shape preference (square, round, almond, stiletto):
Square
Round
Almond
Stiletto
Other
Other
Do you have any nail polish allergies? (yes/no; if yes, which ingredients?):
Please upload inspirational photos:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Acknowledgement
*
I acknowledge that the professionals are Independent Professionals who agrees to acquire and maintain an Independent Contractors permit and license as issued by the Georgia Cosmetology Commission, Georgia State Board of Barber Examiners, Georgia State and/Board. The Independent Professional is using the professional space as a Independent Professional and independent contractor. The Independent Professional IS NOT AN AGENT OR EMPLOYEE OF OWNER OR of J. Salons LLC dba Creative Salon Spaces. I agree to receive services from the Independent Professional and indemnify and hold harmless J. Salons LLC from all liability and claims.
Submit
Should be Empty: