New Client Intake | Maine & Grace

First name

Last name

Do you have any problem areas? (Ex-thin edges, bald spots, breakage). If Yes, I’ll reach out for further details an possibly photos.

Do you have any known allergies? If Yes, please list below.

How did you hear about us?

We like to celebrate our clients for their birthdays. Please let me know birthday to receive special birthday promotions. (Not required)

Month

Day

Year

Do you have any health conditions I need to be made aware of in order to accommodate your visit?