Client Interest Form
Thank you for your interest! Please complete this form to help us understand your hair goals and preferences as we start your protective style journey.
Full Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
E-mail
example@example.com
Direct Instagram Handle
City or area where you reside
How did you hear about JJ’s Hairapy?
Please Select
Instagram
Online Search
Fresha
Employee Referral
Friend Referral
Other
If referred by a friend, please state friend’s name
How would you describe your personality?
How soon do you need an appointment?
As soon as possible
For a specific date/occasion
Not urgent, but I'm hoping to be added
What is the best way to reach you?
Whatsapp message
Email
Text message
Describe your hair texture (Fine, medium or thick)
State of Hair
Natural
Transitioning Relaxer/Keratin
Relaxed
Please upload a current photo of yourself
Upload a File
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Choose a file
Cancel
of
Please upload a current photo of your hair, detangled and free of any style or added hair
Upload a File
Drag and drop files here
Choose a file
Cancel
of
What service(s) are you interested in?
What are your current hair concerns?
Scalp Issue
Shedding/Breakage
Lack of Moisture
Postpartum Hair Loss
Other
If booking for your birthday, please fill below for the birthday experience!
How frequent would you visit?
Every two weeks
Once a month
Every 3 months
Twice a year
Once a year
Is there anything else that I need to know that was not mentioned above?
Submit
Should be Empty: