New Client Consultation Form
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Email *
Full Name *
Email Address
 *
Phone Number
 *
Birthday
MM
/
DD
/
YYYY
Gender
 *
How would you describe your current hair condition?
 *
Required
What chemicals do you use on your hair? *
Required
Have you experienced any hair loss or thinning?
 *
Are you taking any medicine that may affect your hair & scalp?
 *
Services Requested:
Which services are you interested in? (Tick all that apply) 
 *
Required
How often do you shampoo your hair?
 *
Required
What hair care products do you use at home?
 *
Do you have any known allergies or sensitivities to hair care ingredients?
 *
When was your last chemical treatments (e.g., perm, relaxer, keratin treatment)?
 *
When was your last hair color service?
 *
What are you hair goals? *
How did you hear about our salon?
 *
Required
Date:
 *
MM
/
DD
/
YYYY
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