New Client Form

First name

Last name

Cell Phone number

Home Phone number

Email Address

Birth Month

Birth Date

I am(required)

18 or over Younger than 18

How did you hear about me?

Social Media Google Search Personal Recommendation Other

Known Allergies or Sensitivities

Are you on any medications that cause hair loss or skin sensitivity?(required)

Yes No

If so, please explain:

ICE (In Case of Emergency) Name

ICE Phone Number

Upload a profile picture

Drag and drop or click to select a file.

Upload an inspiration photo

Drag and drop or click to select a file.

I would love to have my photo taken for Karen’s portfolio(required)

Yes I would Yes, as long as you can't see my face in the photos No thanks