Appointment Request Form
Please complete & submit to request an appointment. Please allow 48 hours for our response. I look forward to having you in my chair!
Full Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Email Address
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example@example.com
How soon are you looking to book your appointment?
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Please Select
ASAP / First Available
1-2 Weeks
3-4 Weeks
I'm flexible.
Do you have a preferred Day (s) / Time (s)?
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Please Note: Rocco's schedule spans from Tuesday through Saturday.
Service Request / Hair Goal
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What are you looking to have done with your hair? Are you hoping for a big change or to maintain what you have? If you are unsure, write "not sure" and continue to the next prompt.
Hair History
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Please provide a summary of your hair color history within the past three years. Include the type of service (i.e. bleach services, permanent color, hair relaxers, etc.) as well as estimated dates these services were completed.
Do you have grey hair that you wish to cover?
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Yes
No
How much grey hair do you have naturally?
Please Select
Less than 25%
25 - 50%
More than 50%
Upload Current Hair
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Browse Files
Drag and drop files here
Choose a file
Please upload photos of your hair that are clear and unedited. If possible, please take photos demonstrating multiple angles of your hair (front, back, and both sides). This will help Rocco best determine which service(s) will be most suitable based on your requested needs.
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Upload Insiration Goal
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Browse Files
Drag and drop files here
Choose a file
Please upload any hair inspiration photos you feel best showcase your hair end goal. If you need inspiration, feel free to browse through the Hair by Rocco Instagram page - @hair.by.rocco
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POLICIES
If you are interested in Hair Extension Services, the hair extensions must be purchased from Hair by Rocco directly. Additionally, a $30 in-person consultation is required prior to scheduling the extension installation appointment.
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Yes, I understand.
I am not interested in Hair Extension Services.
(1) DEPOSITS - Regarding all extension appointments, a non-refundable deposit is required to finalize scheduling. The total deposit provided will be deducted from the total balance on the day of service. Please note, all deposit transactions are final and are not refundable. If a schedule change is being requested, the total deposit provided to secure the original appointment will be honored so long as the requested schedule change is submitted to Hair by Rocco via text message 24 hours prior to the original scheduled service. Any appointment change requests submitted after this window will result in a forfeit of the original appointment and deposit. A new deposit will be required to schedule a new appointment. (2) CANCELLATIONS - In regard to both new and existing client appointments; If a client has a confirmed appointment with or without a deposit and requires a cancellation or schedule change, the request must be submitted to Hair by Rocco at a minimum of 24 hours prior to the day of service via text message. Any requested appointment changes submitted after this window will result in a forfeit of the original appointment and deposit. (3) LATE ARRIVALS - A 15-minute grace period is allowed for late arrivals. Arrival beyond the 15-minute window may result in: (a) forfeit of the scheduled appointment along with the deposit made if the service is unable to be completed in the remaining time, (b) modification of the end goal to shorten the service length, (c) a $20 surcharge for every 15 minutes of tardiness beyond the grace period should the service be determined achievable in the remaining time.
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I understand and agree to Bellibone Policy.
VIDEO AUTHORIZATION RELEASE
At Hair by Rocco & Bellibone Salon, we love to feature our clients' experience on social media. If you consent to being filmed and featured on @hair.by.rocco, @bellibonesalon, and affiliated platforms, please grant us permission to do so by accepting the terms below.
I herein authorize Hair by Rocco LLC, Bellibone Salon, and affiliated members to use, edit, copy, exhibit, distribute and use any video or videos of me for any lawful purpose. The authorization I provide herein extends to all languages, formats, and media that have been discovered now or will later be discovered. The term of this authorization is indefinite and will be active unless I revoke it in writing. Hereby, I also waive my right to approve and/or inspect a product where I appear or my likeness appears. I also agree and state that I have been compensated for this use of my likeness and/or have agreed to these Video Release conditions without compensation. I hereby waive all and any rights to all royalties or any other compensation in any form when it comes to the use of the video or videos indicated in this form. I consent that the materials will be the sole property of Hair by Rocco LLC and Bellibone Salon and shall not be returned to me. I release Hair by Rocco LLC and Bellibone Salon from any liability, petitions, and causes of actions caused by me or by my heirs, executives or any other party and will hold him/her harmless. *
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YES, I consent to being filmed & featured. I accept the terms & conditions written above.
NO, I prefer not to be filmed.
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