New Client Appointment Request Please provide the following information. "*" indicates required fields Full Name* First Last Your pronouns*What terms are you comfortable with me using in conversation? (ie. queen, king, man, lady, dude, cute, pretty, handsome, etc.)Email* Enter Email Confirm Email Phone number*Referred byDo you agree to the house rules?* I have read over and understand the house rules and I agree to these terms.What services are you requesting?*Preferred date* MM slash DD slash YYYY Preferred time*Please Select12:00 AM12:30 AM1:00 AM1:30 AM2:00 AM2:30 AM3:00 AM3:30 AM4:00 AM4:30 AM5:30 AM6:00 AM6:30 AM7:00 AM7:30 AM8:00 AM8:30 AM9:00 AM9:30 AM10:00 AM10:30 AM11:00 AM11:30 AM12:00 PM12:30 PM1:00 PM1:30 PM2:00 PM2:30 PM3:00 PM3:30 PM4:00 PM4:30 PM5:00 PM5:30 PM6:00 PM6:30 PM7:00 PM7:30 PM8:00 PM8:30 PM9:00 PM9:30 PM10:00 PM10:30 PM11:00 PM11:30 PMIf your requested date is not available please let me know what days & times typically work for you.*Would you like a silent service?*Please SelectYes please!Not this timeIn the past 2 years, how many chemical services DIY and professional have you had performed on your hair? (colour, box colour, chemical straightening, perms, colour deposting shampoos & conditioners)*What are the things you like/dislike most about your hair?Do you have any allergies that I should be aware of?Do you have any scalp conditions that I should be made aware of?Do you have any questions/concerns?Thank you so much for completing the new client appointment request form. Please send your hair inspiration photos and a photo of the front, side, and back of your hair, plus any possible questions you may have to stylebyjillian.clients@gmail.com as soon as possible. If you do not complete this step you will not be considered to book an appointment.* You got it dude!Opt-in I opt-in to receive marketing and promotional materialsCAPTCHANameThis field is for validation purposes and should be left unchanged.
