Hair · New client form
Your health. Your hair. Our priority. Complete this before your hair service so Chinky knows your scalp, your history and your hair before she starts. It reaches her the moment you send it.
The Beauty Experience
Health History Form
Your health. Your hair. Our priority.
Please check Yes or No. Do you have or have you had any of the following?
Diabetes
High Blood Pressure
Heart Condition / Disease
Thyroid Condition
Anemia
Asthma / Respiratory Issues
Epilepsy / Seizures
Bleeding Disorders
Skin Conditions (Eczema, Psoriasis, etc.)
Autoimmune Disorders
Cancer
Depression / Anxiety
Do you have any allergies?
Are you allergic to latex?
Are you allergic to any hair products or chemical ingredients?
Do you have a sensitive scalp?
Do you bruise easily?
Have you ever experienced an allergic reaction to a salon service or product?
Are you currently taking any medications?
Are you pregnant or nursing?
Do you currently have or have you had:
Hair Loss / Thinning
Dandruff / Dry Scalp
Oily Scalp
Itchy Scalp
Scalp Sores / Cuts / Irritation
Ringworm / Lice
Have you had any of the following services in the last 6 months?
Hair Color (Permanent / Demi / Semi)
Relaxer / Texturizer
Bleach / Lightener
Perm
Keratin / Smoothing Treatment
Do you smoke?
Do you exercise regularly?
Do you drink alcohol?
Do you follow a special diet?
I certify that the information provided is true and complete to the best of my knowledge. I understand that withholding information could affect the safety and results of the services provided. I consent to receive the services discussed and authorize The Beauty Experience to use professional judgment in recommending what is best for my hair and scalp health.
Optional — anything you would like Chinky to know about your appointment
Thank you for choosing The Beauty Experience! Healthy hair. Beautiful you. • Healthy hair. Healthy you. Beautiful results.
This comes straight to Chinky before your appointment. Nothing is shared with anyone else.