New Client Intake Form

New Client Intake Form
Name*

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
CANCELLATION & NO-SHOW POLICY

Your time is valuable - and so is mine. To ensure fairness to our myself and availability for all guests, please review my policy below:

APPOINTMENT CHANGES

A minimum of 48 hours' notice is required to cancel or reschedule.
Cancellations within 48 hours may result in a 50% service fee.

NO-SHOWS

No-show appointments will be charged 100% of the scheduled service.
Payment is required before rebooking.

LATE ARRIVALS

Arriving 10+ minutes late may require service adjustments or rescheduling.
This helps us stay on time for all guests.
By booking an appointment, you agree to this policy.

Thank you for respecting my time and supporting my small business
Why Medications Matter in Hair Services

Certain prescriptions, vitamins, and supplements can change the way your hair and scalp react to color, lightening, and smoothing services.

What medications can do:
- Colors may process faster or slower
- Hair may become dry, thin, or fragile
- Scalp sensitivity may increase
- Chemical services can react differently
- Common medications that may affect hair:
(Hormonal medications, thyroid meds, acne and skin treatments, antidepressants, blood pressure medications, steroids, chemotherapy, allergy meds, and some herbal supplements.)

Why I ask:
Your information helps us adjust formulas, timing, and product choices so we can deliver safe, predictable results.

Your privacy matters:
Anything you share is confidential and only used to protect your hair health.

If you start a new medication — please let us know at your next appointment.
Healthy hair begins with honest consultations.

Medications & Health Disclosure

All information is confidential and used only to ensure safe service results
I am...*

NOT taking any medicationsON medicationsChanged medicationsRecently started medications
Please list what the medication is for: (Hormonal medications, thyroid meds, acne and skin treatments, antidepressants, blood pressure medications, steroids, chemotherapy, allergy meds)
Hair History & Disclosure
What is your natural hair texture?*

StraightWavyCurlyCoilyOther
What is your natural hair density?*

Extra FineFineNormalThickExtra Thick
Do you have any scalp conditions?*

DandruffEczemaPsoriasisExcessive DrynessOilinessAlopeciaRecent hair lossTrichotillomania (Hair Pulling)None of the above!
Current Scalp condition:*

NormalDryOilyScars
Allergies to metals, silicone or adhesives?*

YesNo
If yes please explain:
Are you taking or have taken weightless medication in the last year?*

YesNo
If yes, please explain:
What type of water do you mainly wash your hair in? (Well Water, City Water, a mix of both?)*
Please disclose to the best of your ability your hair history for the past 2+ years.*
Hair care products used at home:*
Have you used any drugstore products to chemically change your hair on your own? If yes please disclose what was used and done:*
Is there anything else I should be made aware of?
By clicking below, I have truthful disclosed to the best of my ability information required so my stylist can make the best choice pertaining to my hair history.
Should be Empty: