Date of Birth

MM

DD

YYYY

Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

How did you find out about me? *

FACEBOOK

INSTAGRAM

TIKTOK

GOOGLE

WALK-IN

OTHER

In the past year have you had any of the following services either in or out of a salon? *

Haircut (End Cut, or Stylist Scissors Cut)

Hair color (Hi-Lift Permeant, Box Dye)

Chemical Relaxing or Straightening Treatment

Highlighting or Low-lighting

Full Head Lightening

Permanent Wave or Texturizing Treatment

Protein (Build Bonding)/ Deep Conditioning Treatment

OTHER

PLEASE BE INFORMED of HairBaks BOOKING POLICY: *

1. Clients must book with a non-refundable credit or debit card Reservation Fee and sign the HairBaks Booking Policy Agreement & Photography Policy. 2. All reservation fee will hold your appointment and / or be deducted towards the final cost of the service. 3. The remaining balance of service must be paid in Zelle or CASH. 4. Due to limited Space; therefore, we cannot accommodate any extra guests. 5. To finalize your appointment with me, I kindly ask that you upload a copy of your valid state ID or driver's license. This is just a security measure to ensure the safety and accuracy of our records. *DISCLAIMER NYC SALES TAX IS INCLUDED IN THE PRICE AT THE END OF ALL SERVICE Please send ALL Zelle RESERVATION FEE to: (will be give to you at the end of virtual/In-Person consultation services) Traveling Fee Policy: 6. When booking make sure you TYPE or CLICK “MOBILE SERVICE” and put your address in the comment section on the Booksy booking app. 7. All Uber / Lyft, and parking fees if parking isn’t available or limited will be included at the end of your service. 8. Customer must secure their pets away from the stylist until service is completed. ie: If the pet gets excited when seeing new people. 9. Wait time is 30 mins after the appointment no answer will result in a cancelation fee. Cancellation Policy: 10. Clients have 48hrs (TWO days) before their appointment to cancel or reschedule. If not, the reminding amount of the service will be charged for no-show / cancellation fees. And WILL NOT be able to get another date using the same deposit. 11. Also, there is a $25 late fee added charge for Showing up 1 minute after your 15 minutes grace period to your appointment.

I Agree to all the policies above

Submitting/signing the client intake form *

By submitting/signing the client intake form below, you agree to the following: I have completed this form truthfully and to the best of my knowledge. I agree to inform the technician of any changes in the above information. I agree to a non-refundable Reservation Fee you have read and understood the Agreement and Booking Policies above & within 48 hours (TWO days). Look out for a email to set up a virtual/In-Person Consultation.

I Agree