BEAUTY INTAKE FORM

Time for an appointment?

Complete the short form below to let us know a bit about your hair!
Questions? Give us a call at 262.241.8899.

    Birthday
    How did you hear about us?
    Have you ever used box color?YesNoN/A
    Do you have well water at home or at school? YesNoN/A
    Have you had corrective color within the past two years? YesNoN/A
    Have you had bleaching within the last two years? YesNoN/A
    Have you had perm/relaxer within the last two years? YesNoN/A
    Have you had a keratin treatment in the last year? YesNoN/A
    Are you currently on any prescribed medication? YesNoN/A
    Do you have any allergies we should be aware of? YesNoN/A

    Please include the following photos:

    Photo (front of hair)
    Photo (back of hair)
    What products are you currently using?


    DeRiah Boutique Salon Policies

    • DeRiah salon does not issue refunds. If you are unsatisfied with your hair we are happy to make adjustments for you, but only within 10 days of your service.
    • Your color, keratin or extensions service is only guaranteed if you invest in the recommended shampoo and conditioner from DeRiah Boutique Salon directly. If you do not invest in the recommended shampoo and conditioner we will not perform any redo services complimentary.
    • A redo service has a small fee of $15 per bowl of color needed to make the adjustments and does not include a blowout. We would be happy to blow-dry the front pieces to ensure you are satisfied with the end result.
    • Please note that some complex services may require multiple visits/services to achieve. Your stylist will tell you directly if your goal cannot be achieved in one sitting.
    • No color service is guaranteed if you have box color present in your hair.
    • Every ticket includes a $1.50 eco charge to help remain green.
    • Please note: We do have a 48 hour cancellation policy. Due to the high demand of our stylists, we require a credit card to hold each reservation and we will charge said credit card 50% of the scheduled services 48 hours prior. This dollar amount will be applied to your service total the day of your appointment. This includes no shows and cancellations at the last minute.
    • All appointments must be confirmed within 48 hours in order to reserve the time for the scheduled service. Failure to do so will result in automatic cancellation for that day.