New Client Questionnaire

NEW CLIENT QUESTIONNAIRE
Part I: General Information
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
Phone Number

Area CodePhone Number
E-mail*
Birthday

MonthDayYear
Date
Anniversary(If Married)

MonthDayYear
Date
How did you hear about us?*

Client ReferralFacebookInstagramWebsiteYelpOther
Part II: Hair History
Do you have a chemical service?

YesNo
When was your last chemical service?
What's the name of the chemical used?
Who did your chemical service? Licensed Stylist? Friend? Yourself?
How often do you get your ends trimmed?
Have you ever had a protein treatment?

YesNo
Have you ever had a hydration treatment?

YesNo
Are you on medication?

YesNo
If so, what type of medication?
Do you have any allergies?

YesNo
If so, what type?
How much water do you drink?
How often do you cleanse your hair?
What’s your night time ritual?

WrapPinCurlRollersNothing
What are your hair goals? How can Hair's Kay Beauty Salon best support you in reaching these goals?
Thank you for completing this survey! We will contact you to set up an appointment!
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NEW CLIENT QUESTIONNAIRE