New Client Referral Form

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Please fill out the following so we can update our records.

Email *

First name *

Last name *

Cell number *

Preferred contact method *

Text

Call

Required

Would you like text appointment reminders ? *

Yes

Required

Birthday- Month and day only :-) *

If you become a client, do you plan on receiving services year round? *

Yes

Other:

How Frequently do you get your haircut typically? *

If you do color, how often do you get color and or highlights typically? ( answer only if it applies)

If you do smoothing services like Keratin Express or Keratin treatments, how frequently do you have this service done? ( answer only if it applies)

If you do Hair extensions, what is your typical frequency? . ( answer only if it applies)

My hours of operation are currently Monday through Thursday. please select all that apply generally.

Please select all days and times that you are generally available. *

8AM-12PM

12PM-3PM

3PM-5PM

5PM-8PM

ANY

Not Available

MONDAY

TUESDAY

WEDNESDAY

THURSDAY

A copy of your responses will be emailed to the address you provided.

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