Name *

First Name

Last Name

Phone (Ideally a number that can receive text messages) *

(###)

###

####

Birthday

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

In the past year, have you had any of the following services done to your hair? (Check all that apply)

Haircut

Hair Color

Perm

Relaxer

Highlight or Lowlight

Other

Have you used a box dye in the past 5 years?

Yes

No

Have you ever had an allergic reaction to any products, treatments, or chemicals you've received during any salon visit?

Yes

No

How often do you use a heat styling tool on your hair? (blow dryer, straightener, etc)

Every day

A couple times a week

A few times a month

Rarely ever

Would you like to subscribe to our email list for VIP offers?

Yes

No

Would you prefer a quiet appointment?

A quiet appointment will have minimal conversation. Your stylist will consult with you regarding your hair, however the rest of the appointment will be quiet and relaxing. No pressure for any conversation. We completely respect this choice and love to cater to your preferences.

Yes

No

Have you reviewed our cancelation & no show policy? *

If you have not, please review on our policy page so you are well informed.

Yes

No

Date

MM

DD

YYYY