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 and current routines. Please take a moment now to answer the questions below as completely and accurate as possible.

Please answer all questions honestly and to the best of your ability. If a question does not apply, or is non-applicable, please enter “N/A”.

Full Name *

Date of birth *

Gender Identity *

Address

Street Address *

City

State

Country

Postal code

Phone *

Email *

Preferred Contact Method: *

How did you hear about us? *

If "social media" or "other" please specify: *

Most recent Salon visit? *

Most recent Doctors visit? *

In the past 6-12 months, have you had any of the following services or experiences? *

Please specify services and experiences below: *

What are your 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

Please specify service and experience below: *

Do you have any food allergies? *

Yes

Please specify allergies below: *

Are you currently taking any medications (prescribed or otherwise)? *

Yes

Please specify medications below: *

What scalp and hair care products are you currently using? *

What body and skin care products are you currently using? *

What styling tools are you currently using? *

Have you ever worked with a life coach or nutritionist? *

Please specify service and experience below: *

What specific areas do you want to focus on? (e.g., personal health and/or beauty, professional growth) *

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

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