Pre Hair Appointment Form

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Name* This field is required.
First Name
Last Name
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Email* This field is required.
example@example.com
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Phone Number* This field is required.
Please enter a valid phone number.
4
Pronouns
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How did you hear about us?* This field is required.If someone referred you please let us know who!
6
What Service(s) are you booking/have you booked?* This field is required.If you select hair color please also select 'Haircut or Blowout'
Haircut or Blowout
Waxing or Facial
Reiki
Tarot
Color Service
7
Do you have any allergies or sensitivities?* This field is required.(Skin, fragrance, product etc.)
YESNO
8
What are you allergic to?
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Ok
9
Where are you seeking clarity?* This field is required.You may list up to two specific questions as well as any details you feel are important to share prior to your Tarot reading. You may also simply choose a topic (Love, Career, General Guidance) and receive an intuitive reading.
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10
What is your main goal/concern for this visit?* This field is required.If you are receiving multiple services please share your desired outcome of each.
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Ok
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Are there any injuries, surgeries or recent health conditions you feel are important to share?This helps us further customize your Reiki session.
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When did you color your hair last?* This field is required.
1-3 months ago
3-4 months ago
6-12 months ago
1+ years ago
Never
13
Are you currently under the care of a Physician or Dermatologist for any ongoing health or skin concern? If yes please elaborate.* This field is required.
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If you are currently taking any medications that may effect your skin please list them below.
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Do you have an allergy to latex?* This field is required.
YESNO
16
Have you taken Accutane in the past year?* This field is required.
YESNO
17
Are you using any retinol, Retin‑A, or vitamin A–based products on the area to be treated, whether OTC or prescription?* This field is required.If yes, when was the last time you used it?
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Please select Yes to acknowledge that all exfoliants and vitamin A/retinol-based products must be discontinued on the area to be treated for 5-7 days prior to your service unless otherwise directed by my service provider.* This field is required.
YESNO
19
Have you/will you have taken antibiotics within 4 weeks of your scheduled service?* This field is required.
YESNO
20
Do you consider your skin to be sensitive?* This field is required.
YESNO
21
Do you tend to get ingrown hairs?* This field is required.
YESNO
22
Please upload 2 photos of your current hair.* This field is required.One from the front, one from the side or back. Natural lighting is best (near a window, no flash).
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
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Upload 1-2 photo(s) that reflects your desired look.* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
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Is there anything else you'd like us to know to support your experience?
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