New Client Consultation Form

Name*

First NameLast Name

Date of Birth *

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number

Email (I do not share info. This signs you up for my email list)*

example@example.com

How did you hear about me?*

If Referral, please list name

What are your hair care goals? *

What are your hair care challenges?*

If other please explain...

What are you trying to achieve with your style?*

VolumeCurlStraightOther

Average visits to a salon:*

Every 4-6 weeksEvery 6-12 weeksEvery 3-6 monthsOnce a year

How much styling time is spent at home?*

Less than 15 min.15-30 min.30-45 min.More than 45 min.

What is your home styling comfort level?*

UncomfortableComfortableVery ComfortableI Want some Tips

What kind of styling tools are you using at home during your hair routine?*

Hair Versatility*

Wear my hair the same everydaySometimes wear my hair differently on weekendsOpen to new styles & change oftenTry a new look everyday

Have you ever had a hair conditioning treatment service before?*

YesNo

What hair care products do you currently use?*

What do you wish your hair did more of?

Are you currently taking any prescriptions, vitamins, or hormones? If yes please list the items that may effect your service today.

NoYesOther

Have you ever experienced hair loss or scalp problems?

NoYesOther

Do you presently have any breakage, thinning or bald spots?*

NoYesNot sure

Used box color (at home color remedy)

Have you ever received a chemical straighter or relaxer service or treatment?*

Yes, within the last monthYes, within the last 6-12 monthsNo

Please feel free to go into more detail about any questions you may have for your stylist

I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the hair service being received.*

Yes

Signature*

Please take a couple hair selfies in natural, indoor lighting

Upload a picture of your hair goals

What about this picture do you like?

Client Intake Form

Your Hair Profile

Hair History

Please select any of the following chemical hair services you’ve received either professionally or at home.