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

Format: (000) 000-0000.

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?

Other

Average visits to a salon:

How much styling time is spent at home?

What is your home styling comfort level?

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

Hair Versatility

Have you ever had a hair conditioning treatment service before?

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.

Other

Have you ever experienced hair loss or scalp problems?

Other

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

Used box color (at home color remedy)

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

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.

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.