Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Are you 18 years or older? *

Yes

No

Do you know which head spa service you are interested in? *

If you aren't sure we can discuss which would be best for you.

Head Spa Detox Treatment

Luxury Scalp Spa Treatment

Maintenance Scalp Facial

Dry Head Spa Treatment 30 minutes

Dry Head Spa Treatment 60 minutes

Not sure

Do you want to add on any luxury hair treatments to complement your head spa service? *

If you aren't sure we can discuss which would be best for you.

Intensive Repair Treatment

Glass Shine Treatment

Bond Building Treatment

Not sure

Are you interested in any other services?

Balayage

Hair coloring/ cutting

Hair extensions

Skin care

Facial waxing

Beauty classes

Event hair and makeup

Wedding services

Other

You have read and understand the cancellation policy. You understand that if less than a 24 hour notice is not given for all appointments, a cancellation or rescheduling fee of $30 will apply. Same day $50 fee will apply. Thank you for understanding. *

Yes