New Client Intake Form
Hair by Brelyne Belnap
Client's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Client's Phone Number
Format: (000) 000-0000.
Client's Email Address
example@example.com
Occupation
Select a hair service
Adult Hair Cut
Cut & Shampoo
Hair color (Permanent)
Hair color (Semi)
Hair Color Blending
Hair Conditioning
Hair styling (Formal)
Hair styling (Special Occasion)
Highlights
kids Cut
Other
What hair style do you like?
Upload an image of hair style or hair color you prefer
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
Upload an image of your current hair
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
How long is your hair?
Short
Medium
Long
Other
What is the current condition of your hair?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Other
What is the condition of your scalp?
Dry
Normal
Oily
Other
How often do you apply shampoo and conditioner in your hair?
Every day
Every other day
Twice a week
Once a week
Other
Have you use the following in your hair before?
Permanent hair color
Keratin Treatment
Razor cut/Thinning
Relaxer
Henna
When did you last visit a hair salon?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
When did you last apply professional or unprofessional color in your hair?
please tell me what products that you are using
What are the tools you are using to style your hair?
How did you hear about us?
Facebook
Instagram
Google Search
Referred by a friend
Other
Any special instructions, comments, or suggestions?
By signing below, I agree to the terms and conditions of the salon company.
Client's Signature
Date Signed
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Print Form
Submit
Submit
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