CLIENT CONSULTATION FORM
Cocoa Brown, Hairstylist and Manicurist
http://www.cocoashair.com
310-658-4967
e-mail: cocoab4u@yahoo.com
Client Consultation and Profile Form
IN ORDER FOR THE HAIRSTYLIST TO BEST SERVICE YOUR HAIR/NAIL NEEDS, PLEASE ANSWER THE FOLLOWING QUESTIONS:
*2. Are you currently taking any medications?
yes
no
*3. Do You Have Any Of The Following?
Diabetes Heart Disease Thyroid Problems Circulatory or Muscular Disease Hypertension Cancer Allergies Other none
*4. Is Your Skin:
Oily
Dry
Normal
Combination
*5. Do you have a history of picking or biting your nails?
yes
no
*7. Have you ever had an allergic or severe reaction to any chemicals due to any hair or nail services in the past?
yes
no
*8. Have you ever experienced a nail infection of any sort?
yes
no
11. Do you agree to keep a regular appointment schedule to maintain your hair/nail conditon or enhancement for long term style and wearability?
yes
no
no response
Cocoa Brown, Hairstylist and Manicurist, Reserves the right to charge additional fees for appointments canceled and rescheduled more than twice as agreed by client and the hairstylist via phone or sit down consultations. Due to potentially hazardous chemicals during hair/nail services given by the professional, Cocoa Brown, Hairstylist and Manicurist, will not be held accountable for injuries or accidents to, or caused by unsupervised children and or adult clients.
Stylist Signature: A.B. "Cocoa Brown"