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Luxury With Leila - New Client Intake Form
Full Name:
First Name
Last Name
Phone Number:
Format: (000) 000-0000.
Email Address:
example@example.com
Preferred Method of Contact:
Hair History
When was your last professional hair service?
Less than months
3-6 months
6+ months
Other
Have you colored your hair in the last 3 years?
No
Other
Have you ever used box dye, henna, or metallic salts?
No
Other
Color + Goals
What are your current hair goals?
Soft & glossy
Dimensional brunette
Base/gray coverage
Gloss/tone refresh
Major transformation
Haircut
Keratin/ express treatment
Other
What do you love about your hair right now?
What do you NOT love or want to change?
How do you prefer your hair to feel/look?
Soft & glossy
Bold & high-contrast
Natural & low-maintenance
Bright & blonde
Rich & deep
A most recent picture of your hair
Browse Files
Drag and drop files here
Choose a file
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Send in your hair dreams!
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Lifestyle + Maintenance
How often do you realistically plan to come in?
6-8 weeks
8-12 weeks
12+ weeks
How much time do you spend styling your hair?
Minimal
Moderate
love styling
Do you use professional hair products at home?
Yes
No
Sometimes
Health + Sensitivities (Important)
Do you have any allergies or sensitivities to hair products?
No
Other
Are you pregnant, breastfeeding, or under medical care that may affect your service?
No
Yes
Are you currently taking any medications or supplements that affect hair or scalp?
No
Yes
Expectations + Trust
On a scale of 1-10, how open are you to professional recommendations?
Consent
Do you consent to photos/videos being taken of your hair for educational or marketing purposes?
Yes
No
Final Notes
Is there anything you would like me to know before your appointment?
Submit
Should be Empty: