DMHC Waitlist

Name:

First

Last

Address:

Address Line 1

Address Line 2

City

State

Zip Code

Birth Month & Day:

(You are always royalty to us, but we'll make it a bit more special on your birthday!)

Cell Phone:

E-mail *

** We remind you of our appointment 2 days prior to your visit by text and email ** Please keep our cancellation policy in mind

Referred by:

Allergies:

(latex, nylon, chemicals, etc.)

Home Hair Care:

(name of shampoo/conditioner and any other styling products)

How many times per week to you shampoo your hair?

How often do you visit your current salon/hairdresser?

Please describe the expectations and goals you have for your hair:

Message