fill out the form and I will be in touch soon!

NEW CLIENT FORM

If you are interesting in being a client, please fill out the form below and I will be in touch with you shortly! Existing clients please call, text or email me for your follow up appointment.

First name*

Last name*

Email*

Phone*

TELL ME ABOUT YOUR HAIR AND WHAT YOU ARE LOOKING FOR

Multi choice*

Women's haircut

Color service

Hand tied extensions

Other

Please describe what you have in mind! Be as detailed as possible.

How would you describe the density of your hair?

Fine

Medium

Thick

What is your current hair length?

How would you describe your scalp?

Oily

Dry

Normal

Is your hair naturally curly, wavy or straight?

Have you used any at home box color in the last 5 years?

Yes

How would you describe the current condition of your hair?

Healthy

Slightly damaged

Dry and brittle

Please upload a photo of your current hair:

Please upload a photo of your GOAL hair!

You should receive a response within 24-48 hours. If you have not heard back within that time, please feel free to send me a text at 541-601-4267 or email me directly at becky@beckybrackettcollective.com

How did you hear about me?

Google

Facebook/Instagram

Referral

Other

If someone referred you, please list them here so I can thank them!