Heather Stein

Digital Consultation + New Client Inquiry Form

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CLIENT INFORMATION
Full Name: (required)
Preferred Name (if different):
Phone Number: (required)
Email Address : (required)
How did you hear about Heather Stein? (required)
Referral/Other: (required)
CURRENT HAIR STATUS
When was your last professional hair appointment? (required)
Have you ever used any of the following on your hair? (Select all that apply) (required)
If yes, please explain when and what was used:
CHEMICAL & SERVICE HISTORY
Please check any services you’ve had in the past 3 years: (required)
Have you ever experienced an adverse reaction to hair color or chemical services? (required)
If yes, Please Explain
SCALP & HAIR HEALTH
Do you currently experience any of the following? (required)
If applicable, please explain:
MEDICAL / LIFESTYLE CONSIDERATIONS
Are you currently experiencing or have you recently experienced any of the following that may impact your hair? (required)
HAIR GOALS & EXPECTATIONS
How would you describe your current hair concerns? (required)
What is your primary hair goal today? (required)
Please upload 2–3 clear photos of your current hair: Natural lighting, Front and back views, Hair worn down (required)
JPG or PNG. We’ll upload it with your response. Selected — tap change to pick another.
upload 2 current hair (optional)
JPG or PNG. We’ll upload it with your response. Selected — tap change to pick another.
upload 3 current hair (optional)
JPG or PNG. We’ll upload it with your response. Selected — tap change to pick another.
Please upload 1–3 inspiration photos that represent your desired outcome. (required)
JPG or PNG. We’ll upload it with your response. Selected — tap change to pick another.
goal photo 2 (optional)
JPG or PNG. We’ll upload it with your response. Selected — tap change to pick another.
goal photo 3 (optional)
JPG or PNG. We’ll upload it with your response. Selected — tap change to pick another.
MAINTENANCE & INVESTMENT
How often are you comfortable returning for maintenance appointments? (required)
Are you open to professional at-home care recommendations to maintain your results? (required)
Which investment range best aligns with your expectations per appointment (before gratuity)?
STYLING PREFERENCES
How do you typically style your hair? (required)
What finish do you prefer? (required)
i love sharing on my socials, but your comfort always comes first! please answer below so i know what youre comfortable
Are you comfortable with photos or videos being taken during your appointment? (required)
If content is taken, are you comfortable with your face being shown? (required)
If you selected “certain angles,” please specify:
Would you ever be open to: (required)
If we record part of the consultation, are you comfortable with: (required)
Anything else you'd like me to know about content boundaries?
You will receive the same level of care, customization, and attention whether you choose to participate or not.
Final step
Your contact details
We’ll use this to attach your responses.