Online Appointment Request

Name
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Street Address:
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City:
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State/Province:
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Post Code:
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Contact E-Mail
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Contact Phone #
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How did you find us?
Business Card - Where?
Flyer - Where?
Referral - Who?
Internet - List Search engine & search words used
Date & Time Preferred
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Preferred Stylist?
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Please check any of the following that apply. Hair Cut
Color
Highlights
Relaxer
Keratin/Brazilian
Hair Repair
Tanning
Waxing
Nails
Makeup
Hair Extensions
Eyelash Extensions
Permanent Makeup
Skin Services
Hair Styling
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If this appointment is for Hair Extensions or for a Formal Event, you must have had a consult first. Please fill out the consult form if you have not done so. Otherwise, please give us details on the above requested services.
Is there anything you feel you need to tell us that is pertinent before obtaining these services?
I have read, understood & agreed to the Rapunzel Studio Company Policy. Yes
No
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Will you let us use your image for marketing purposes? Yes
No
Maybe

Electronic Signature
( Please type your name )
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