Client Information
We love our clients @Dare 2 Be Different Salon.  In efforts to give you as much of my time in your appointment, This initial intake form will help us get to know you better to help provide you with the best hair care experience possible.
Email *
First and Last Name *
Address
Phone number *
Date of birth *
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Email Address *
where you referred by someone? *
Required
when was the last time you had any  type  of hair color(by yourself or professionally done) *
which of these describe your hair? *
Required
how would you describe your hair condition? *
Required
what service do you normally have done? *
Required
Are you sensitive to, or have you suffered a reaction from any scalp related treatments or chemicals? *
Do you suffer from any allergies? *
What products do you currently use?
Have you ever suffered from hair loss? *
Have you ever been Diagnosed with alopecia? *
Have you been pregnant in the last 6 Months? *
Do you suffer from psoriasis to the scalp? *
Do you have sensitive scalp? *
Do you have suffer from eczema of the scalp? *
Have you ever used hair extensions before? *
Required
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