Name *

First Name

Last Name

Phone

(###)

###

####

APPOINTMENT PREFERENCE *

Preferred appointment days (Select all that apply)

Thursday

Tuesday

Wednesday

Friday

Saturday

Morning

Afternoon

Evening

Preferred salon environment: *

Complete silence

Low background music

Regular salon atmosphere

How often do you plan to maintain your hairstyle? *

4-6 weeks

6-8 weeks

8-12 weeks

Other

Current Hair Condition: *

Select all that applies

Heat Damaged

Breakage

Chemical Damage

Normal

Split Ends

Dry/Brittle

Oily

Hair density: *

Fine

Medium

Thick

Thin/Thinning

Have you had chemical services in the last 6 months?

Yes

No

Do you have any scalp conditions your stylist should know?

Yes

No

Are you pregnant?

Yes

No

Are you seeking a permanent salon home? *

Yes

No

Have you visited a holistic clean beauty salon before? *

Yes

No

What aspects of a salon are most important to you?

Check all that apply

Clean. eco friendly environment

Holistic approach to hair care

Professional expertise

Consistent styling results

Relationship with stylist

Price transparency

Appointment Availability

All inclusive service

Would you like to utilize our remote work amenities?

No

Yes

If yes, please select what you'll need:

Wifi access

Desk workspace

Charging station

Quiet space

Holistic Beauty Preferences

Are you interested in learning about our:

Natural hair care products

Hair wellness consultations

Holistic hair care education

Human hair braid services

Scalp treatment services

Date

MM

DD

YYYY