Name
              
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                    First Name 
                   
                
                
                  
                     
                    Last Name 
                   
                
               
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Preferred Pronouns
              
             
          
                
                 
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Phone
              
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                    (###) 
                   
                
                
                  
                     
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                    #### 
                   
                
               
            
            
        
          
          
            
            
            
            
            
              
                
            
              Email
              
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              Date of Birth
              
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              Please give a detailed description of your goals for this appointment.
              
             
          
                
                
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Here are some key words or terms to help you describe what you'd like. Select as many as you'd like!
              
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                  Haircut with shampoo
                
                  Dry haircut
                
                  Kid's (12 & under) dry haircut
                
                  Kid's (12 & under) haircut with shampoo
                
                  Shampoo and style
                
                  Natural color
                
                  Root retouch
                
                  Highlights/Balayage
                
                  Color correction
                
                  Vivid color
                
                  Gloss/Toner
                
                  Money piece
                
                  Color block piece
                
                  Eyebrow wax
                
                  Lip wax
                
                  Deep conditioning
                
                  Other
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              I'd love to see your vision! Upload inspiration photos here.
              
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                FileField; MaxSize=1000000KB; Multiple; addText=Upload_Your_Files
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Do you have professional or at home color in your hair currently? If so, when was this done?
              
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              I need some background. Upload clear, recent images of what your hair looks like currently, please.
              
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                FileField; MaxSize=1000000KB; Multiple; addText=Upload_Your_Files
                
               
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              How often do you go to the salon for services?
              
             
          
                
                
                
                  
                    Every week 
                  
                    Every 2 weeks 
                  
                    Every 3-4 weeks 
                  
                    Every 2 months  
                  
                    Every 2-6 months 
                  
                    Twice a year 
                  
                    Once a year 
                  
                    Other 
                  
                   
                 
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              How long is your hair?
              
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                    Very short - scalp to ears 
                  
                    Short - ears to middle of neck 
                  
                    Medium - middle of neck to shoulder 
                  
                    Long - shoulder to middle of back 
                  
                    Very Long - middle of back and longer 
                  
                   
                 
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              What is the condition of your scalp?
              
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                  Dry
                
                  Normal
                
                  Itchy
                
                  Painful
                
                  Oily
                
                  Flaky
                
                  Patchy
                
                  Other
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              What is your hair type?
              
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                    Straight 
                  
                    Wavy 
                  
                    Curly 
                  
                    Very Curly 
                  
                    Coils 
                  
                    Other 
                  
                   
                 
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              What is the thickness of your hair?
              
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                    Very thick 
                  
                    Thick 
                  
                    Medium 
                  
                    Fine  
                  
                    Thin 
                  
                    Not Sure 
                  
                    Other 
                  
                   
                 
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              What is the current condition of your hair?
              
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                  Hair loss
                
                  Damage due to heat or lightening
                
                  Split ends
                
                  Breakage
                
                  Dry
                
                  Brittle
                
                  Smooth
                
                  Healthy/Normal
                
                  Other
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Have you done any of these in the past 6 months?
              
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                  Permanent hair color
                
                  Lightening/Bleaching
                
                  Keratin treatment or Brazilian Blowout
                
                  Razor cut/Thinning
                
                  Relaxer
                
                  Henna
                
                  Perm
                
                  None of the above
                
                  Other
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              Do you have any concerns in regards to your hair or scalp health that I should be aware of?
              
             
          
                
                
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              Do you have any health conditions I should be aware of?
              
             
          
                
                
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              Please list any hair products you are currently using.
              
             
          
                
                
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
              
                
            
              Do you have any allergies or sensitivities? Please list them below.
              
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              What's your ideal energy level for a service?
              
             
          
                
                
                
                  
                    High to normal energy - talking, laughing, upbeat music 
                  
                    Normal energy - upbeat or relaxed music, talking, quiet pauses 
                  
                    Low energy - relaxed music, less talking 
                  
                    Silent appointment - no talking, little or no music 
                  
                   
                 
              
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Scalp massage? This is the standard scalp massage I give each client unless otherwise stated.
              
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                    Yes please! 
                  
                    A quick one. 
                  
                    No thank you, do what you need to do and nothing else. 
                  
                   
                 
              
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Which add-on would you like?
              
             
          
                
                
                  Extended scalp massage - 10 minute massage
                
                  Scalp exfoliation treatment 
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Budget?
              
             
          
                
                 
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
              
                
            
              Your availability?
              
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              May I have permission to take photos and/or video of your hair before, during, and after your service? Please answer yes or no and initial.
              
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              May I have permission to post the photos and/or videos mentioned above to my social media accounts, Google, portfolio, online, etc? Please answer yes or no and initial.
              
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              Is there anything else I should know about you, your hair, or in general before your service?
              
             
          
                
                
              
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              How did you hear about me?
              
             
          
                
                
                  Facebook
                
                  Twitter
                
                  Instagram
                
                  Google
                
                  Friend 
                
                  Other
                
               
            
            
            
            
            
            
            
            
        
          
          
            
            
            
            
            
            
            
            
            
            
            
            
            
            
            
              
                
            
              Please enter today's date
              
             
          
                
                
                  
                     
                    MM 
                   
                
                
                  
                     
                    DD 
                   
                
                
                  
                     
                    YYYY