New/ Current Customer Registration Form

Customer Details:
Full Name*
First NameLast Name
Address*
Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Cell Phone Number*
Area CodePhone Number
E-mail
Are you a current or new client?*
Who is your Service Provider?*
Tell us about your hair and skin needs for this appointment
Tell us about any of your products needs also so we can better prepare for your visit.
Give detail information about any home hair/skin services that have been done. Ex: color (lighter/darker), cuts, perms, facials, mask etc.
Is your availability flexible? If not give preferred time/day
YesMaybeNoOther
If your Stylist/ Service Provider is not available do you have a preference of another Provider ?
Name of Provider
1
2
Should be Empty:

	Name of Provider
1
2

Customer Details: