Slick's Back-to-Salon Form (template)

Name*

First NameLast Name

Mobile Number*

Please enter a valid phone number.

Alternative Number

Please enter a valid phone number.

Email Address*

example@example.com

Birth Date

MonthDayYear

Do you have any allergies?*

YesNo

If yes, please provide details:

Have you used any box dye or home colour kits since your last visit?

YesNo

If 'Yes' please list what you used and whether you showed any allergic reactions. If 'No' type 'N/A'

Have you been tested positive for Covid-19 since your last visit?

YesNo

As of today, are you showing any Covid-19 related symptoms?*

YesNo

Do you have any special access requirements?*

YesNo

If yes, please provide details on how we can support you:

Do you have any other special requirements?*

YesNo

Is yes, please provide details:

Would you be interested in out 'Click & Collect' products and colour-at-home kits?*

YesNo

Please sign to confirm the above information

The Slick Salon - Back to Salon Form