New client request form

Appointment Request
Currently on a waitlist for new clients

When cancellations occur, or a spot opens up we will go off of the list to fill the spot.
Hair color starting at $295
Haircuts $65
Full Name *

First Name Last Name
Phone - Text only *

Area Code Phone Number
E-mail *
Address

Street Address

Street Address Line 2

City State
New Client to Becky?

Yes No
What day(s) work best for you? Becky is currently in the salon on Monday and Thursday. The latest appointment for a new client is 2:00pm *

Monday Thursday
What type of appointment are you requesting?

Color only Color + Haircut
Has your hair ever been colored, lightened or chemically treated in any way? *
If Yes, please explain. Please note if there is permanent color on the hair.
PLEASE SUBMIT AT CURRENT PHOTO OF THE FRONT AND BACK OF YOUR HAIR (PREFERABLY IN NATURAL LIGHT). AS WELL AS A GOAL PHOTO OF WHAT YOU ARE HOPING TO ACHIEVE.
FRONT *
BACK *
GOAL PHOTO *
GOAL PHOTO
Additional Comments
Should be Empty:

Appointment Request