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Client Intake

Our sincerest hope is to provide all clients with the best health, hair, and/or skin care services ever received. We not only want you to be happy with today's session, we want to build a long lasting relationship with you. In order for us to accomplish this, we would like to learn more about you, your health, hair and/or skin care needs, as well as your preferences. Please take a moment now to answer the questions below as completely and accurate as possible.

Full Name

Gender Identity

Date of Birth

Full Address

Phone

How Did You Hear About Us?

Referred By

Recent Salon Visit

Recent Doctor Visit

In the past year, have you had any of the following services or experieces?

Chemical Relaxing or Straightening

Haircolor

Highlighting or Lowlighting

Major Health Diagnosis

Minor Health Diagnosis

Permanent Wave or Texturizing

Skin Treatment (any)

Nothing

Service Expectations

Are you now, or have you ever been, allergic to any of the products, treatments, or chemicals received during any salon service?

Yes

Do you have any food allergies?

Yes

Are you currently taking any medications?

Yes

Current Hair Product Usage

Current Skin Product Usage

Current Hair Styling Tools

Would you like to be contacted via email about upcoming promotions and special events?

Yes

I hereby understand that all services provided are based, in part, on my responses to the above listed questions, which I have answered honestly, to the best of my ability. Also, I recognize and agree not to hold my specialist or Complete Beauty Solutions, LLC liable for any adverse reactions I may experience due to personal product usage, by preference, outside of any treatments agreed upon during my scheduled session.

We appreciate your time and look forward to building a relationship!