Client Intake Form

Client Intake Form

Client Intake Form

Dear Client,

Our sincerest hope is to provide you with the best services you've ever recieved!  We not only want you to be happy with today's visit; we also want to build a long-lasting relationship with you.  In order for us to do so, we would like to learn more about you, your haircare needs and yuor preference.  Please take a moment now to answer the questions below as completely and as accurately as possible.

Thank you and we look forward to building a relationship!

Name    *    


Phone        E-Mail Address         

Gender        Age


How did you hear about our salon?        *

If you were refered, who refered you?    *

Please answer the following questions in the space provided:

Approximately how long ago was your last salon visit? 

In the past year have you had any of the following services either in or out of the salon? Check all that apply

***Haircut         *Haircolor         Permanent Wave or Texturizing Treatment

Chemical Relaxing or Straightening         Highlighting or lowlighting         Full Head Lightening

Manicure         Artificial Nail Services         Pedicure         Facial/Skin Treatment



What are your expectations for your service(s) today? 

Are you now or have you ever been allergic to any of the products, treatments, or chemicals you've recieved during any salon service - hair, nails, or skin? (If yes, please explain)


Are you currently taking medications? ***YES    NO

If so, please list***

Please list all products you use on your hair on a regular basis.

What tools do you use at home to style your hair? 


What is the one thing you would like your sylist to know about you and/or your hair?


Are you interested in recieving a skin care, nail care or make-up consulation? Yes    No

Would you like to be contacted via e-mail about upcoming promotions and special events? *Yes    No



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