Client Intake Form

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email Address*

example@example.com

Please upload 3 photos of your hair, front view of your hair, side view of your hair and back view of your hair split in half to see any banding.

Upload 3 Photos

Please upload a photo of your hair inspiration.

Upload Photo

When was your last color service

Was there permanent color on your hair?*

YesNo

Has your hair ever been box dyed or colored at home? (This includes SALLY'S)*

YesNo

Has your hair ever been colored black?*

YesNo

If so, how many times?

When was the last time?

Has your hair ever been colored red?*

YesNo

If so, how many times?

When was the last time?

Do you have grey hairs to cover?*

YesNo

If so, how many times?

Do you, or have you ever put henna on your hair? Please answer this question honestly; if your hair was previously exposed to henna it could pose a risk for smoking or catching fire.*

YesNo

Are we maintaining what you currently have or are we making a change?*

What do you not like about your current hair?*

Do you have hair extensions?*

YesNo

If so, what kind?

Do you have natural curl/wave to your hair?*

YesNo

Do you plan on wearing it curly? (50-100% of the time)?*

YesNo

Have you ever had any type of chemical relaxer? (Brazilian Blow Out, etc.)?*

YesNo

If you wish to wear your hair curly 50-90% of the time; what at-home styling products are you using? (shampoo, conditioner, creams, gels, foams etc.) Please list all.

How did you hear about us?*

Are you interested in extensions?*

Before booking with us, please agree to the following Central Coast Platinum's policies:

CANCELLATION POLICY: If we receive less than 72 hours notice you will be charged 50% of your service price. If less than 24 hour notice is given 100% of the service will be charged. If for some reason we cannot charge you, you will not be able to make an appointment with any stylist at Central Coast Platinum until that fee is paid and 50% of your future service is paid upfront as well.*

Will you allow Central Coast Platinum to use your photos in all web-based publications and promotion for Central Coast Platinum and the stylist's individual promotion*

YesNo

Before booking with us, please agree to the following Central Coast Platinum's policies.

Client's Signature*