Dress for Success Auckland Client Dressing Service

Name*

First nameSurname

Mobile number:*

Email address:*

example@example.com

Address*

Street Address

Suburb

CityPostcode

Country

Date of Birth:*

Date

How do you identify yourself:*

FemaleTransgenderGender neutralOther

Single Parent:*

Name of the organization that referred you:*

MSD (WINZ) Client number (if any):

Have you secured a (Transition to Work) fee for this service from your Case Manager?

Is this your first or second dressing appointment with DFSA:*

Are you booking a virtual dressing or visiting a DFSA showroom:*

A virtual appointmentVisiting our Manukau showroomVisiting our Grafton showroom

This dressing service is for what purpose:*

Ethnic Group:*

Age Range (in years):*

Clothing size for tops/jackets:*

Clothing size for hips e.g. pants/skirts/dresses:*

Shoe size indication:*

5 -6 (35-36)7 (37)8 - 9 (38-39)10+ (40+)

Permission to contact you regarding our Career Centre employment support programme:*

Permission to add you to our mailing list for information on DFSA community sales, news and events:*

Dressing Service Appointment*

Media preference for service:*

FacetimeMessengerWhats App

Provide your media User Name for us to connect for this appointment:*

Authorization: The information on this form is collected for Dress for Success use only. The combined data of all our clients is needed for statistical reporting and
funding purposes. I give consent to Dress for Success to record this information and agree to comply with all Health and Safety requirements when visiting a DFSA showroom or being available for a video virtual dressing at an arranged time.

I consent to the above authorization and agreements:*

Date:*

Date

Thank you for booking our Dressing Service and best wishes for a great experience. We'll connect with you soon to confirm details with one of our stylists!

Going places, going strong!

Dress for Success Auckland Client Dressing Service

Virtual Appointment Details