Client ProfileAny information obtained in this profile is strictly confidential. Name * First Name Last Name Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Email Would you like to receive promotion and newsletters by email from our salon? Yes No Today's Date MM DD YYYY Birthday MM DD YYYY Anniversary MM DD YYYY Occupation Driver's License Number If you will pay by check. Driver's License Expiration MM DD YYYY How were you referred to our salon? Please check one. Direct mail Friend Internet Newspaper Penny Power Radio Yellow pages Walk-in If referred by a friend, what's their name? Please check any services that would be of interest to you. Check all that apply. Body Massage CHI Permanent Hair Straightening Facials Hair color Hair Extensions Haircut Highlight LED Light Therapy Make-up Manicure Microdermabrasion Nail Enhancements Paraffin Treatments Pedicure Perm Texture Wave Waxing Is there a service you would like our salon/spa to offer? Do you have any allergies? If so, please describe. Are you taking any medications? If so, please describe. What qualities do you look for in a stylist? Please tell us about previous salon/spa experiences. Any additional information you would like to share. Hair Care I would describe my natural hair color as Black Blonde Brown Grey Red I would describe my hair texture as Straight Curly Wavy Fine Medium Coarse Length that works best for me is Short Medium Long The condition of my hair is Normal Damaged Permed Oily Color-Treated Dry/Brittle Relaxed Every day I do the following to my hair Shampoo Blow-dry Use a curling iron Use a flat iron Use hot rollers I'm having a bad hair day when my hair gets Frizzy Flat Dull Faded Split Ends Fly-aways Unmanageable Too full I want my hair to be Full Shiny Straight Curly Protected from fading Healthy Smooth Dried quickly Soft Strong Protected from sun I am willing to spend this much time on my hair 5 min 15 min 30 min 45 min 60 min I use the following products on my hair Shampoo Conditioner Treatment Gel Wax Mousse Paste Cream Hairspray Hair Color Services Informed Consent I understand that a small percentage of individuals can experience adverse reactions due to application of hair-coloring products. These reactions can include burning, redness, itching and/or swelling. Some persons develop chemical burns on the scalp or hairline. Further, I have been informed that a small percentage of individuals may react to hair-coloring even though they have never had a reaction in the past with repeated applications. I also know that my colorist/stylist at West End Styles, Inc. can give me a patch test, which determines whether or not I will experience a reaction to hair-coloring. This patch test must be given 48 hours (two days) before my appointment for hair-coloring. I have read and understand the information above. I choose to forgo the patch test, and direct West End Styles, Inc. to proceed with the coloring of my hair at this time. By signing this waiver, I hold harmless West End Styles, Inc., including owners and employees from any liability arising from the application of hair-coloring products from this date forward. Signature First Name Last Name Thank you!