PINE AND SALT SALON
New Client Form
Full Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Email Address
example@example.com
Phone Number
Format: (000) 000-0000.
Occupation
Instagram Handle
How did you hear about us?
Preferred Hair Stylist
What would you like to achieve during your appointment?
What products are you using on your hair?
What are your primary hair concerns?
Have you experienced any of these in the last year?
Thinning
Dry Hair
Breakage
Greasy Hair
Split Ends
Flakey Scalp
Scalp Irritation/Burning
Frizz
Lack Of Volume
Damage
Have you ever colored your hair at home:
Yes, in the last 90 days
Yes, in the last 6 months
Yes, in the last year
Yes, over a year ago
Years ago or never
Have you ever had an adverse reaction to hair color?
Yes
No
Why did you leave your last hairstylist?
How often do you like to come into the salon?
What is your anticipated budget for your upcoming appointment?
Less than $100
Less than $150
Less than $200
Less than $250
Less than $300
Less than $350
Less than $400
$400+
Would you like to receive updates from our salon via email?
Yes
No
Date Signed
-
Month
-
Day
Year
Date
Client's Signature
Submit
Submit
Should be Empty: