Barber Shop Client Intake Form

An intake form that lets a barbershop learn each client's hair and grooming preferences and keep a record of their history before the first visit.

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Client Name

First Name

Last Name

Birth Date

Phone Number

Address

Street Address

City

State / Province

ZIP / Postal Code

How did you hear about us?

Social media Friend referral Google search Walk-in Advertisement

Emergency Contact Name

First Name

Last Name

Relationship

Phone Number

What is your hair type?

Straight Wavy Curly Coily

Is your hair color treated?

Yes No

What type is your scalp?

Oily Dry Normal Sensitive

What type is your hair texture?

Fine Medium Coarse

Do you have dandruff?

Yes No Sometimes

Please provide your further comments.

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