Client Intake Form

Welcome to our salon! We're thrilled to have you here and can't wait to help you look and feel your best. To ensure we provide the highest level of personalized care, please take a moment to complete our client intake form. Your comfort, preferences, and hair goals are our top priority. Let's start your beauty journey together!

Name

First Name

Last Name

Health Questionnaire

Diabetes

Pregnant

Epilepsy

High Blood Pressure

Allergies

Skin Condition

Accutane, Retanoids, Benzoyl Peroxide, Antibiotics (Topical or Oral), Salicylic Acid

Additional Health Information

Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Emergency Contact

Name and Phone Number

Date of Birth

MM/DD/YYYY