Pre-Appointment Check-in
Let's take a few minutes before your appointment to set up our time for success. Please review all items & comment with anything we need to focus on during your visit.
Sign in to Google to save your progress. Learn more
Email *
Name *
Health Notice *
By confirming your appointment you agree you are feeling well & to the best of your knowledge, have not been directly exposed to Covid-19/Flu or are not contagious. If you are not feeling well please text me as soon as possible to reschedule after the suggested 10 day incubation period has passed.
Required
I am experiencing the following issues with my hair &/or scalp: *
Required
I am considering a change in my hairstyle & I want to make sure we discuss the following:
Have you had a change in your medications, a new medical issue, had Covid, extreme diet change, or surgery with anesthesia since your last hair appointment? *
I promise I'm not being nosey, some medications & illnesses can cause your hair & color services to not process correctly. Just let me know if it's arthritis, blood pressure, Thyroid, diet, etc.
I would like the following added to my appointment if there is time.
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy