First and Last Name:
*
Phone Number:
*
Email Address:
*
Are you a new client?
Yes
No
Please note that I take appointments on Tuesdays from 3-7, Wednesday's Friday's and Saturdays from 11-5. If you need immediate assistance, please call me at 423-987-5262. Thank you, Lana
Desired appointment date:
If this time is unavailable, what alternate date and time do you prefer?
Desired appointment time:
11 am
12 pm
1 pm
2 pm
3 pm
4 pm
5 pm
6 pm
7 pm
What Services are you in need of?
Designer Haircut
Designer Highlights/Color
Waxing
The Works (Cut, Color, Wax)
Speciality (Wedding, Chem. Straightening, Styles)
Do you have short hair or long hair?
Short hair
Long hair
Please list your comments or let me know who referred you.
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