Intake Form

Mission Valley's Premiere Japanese Headspa

Sola Salon || 5171 Mission Center Rd. San Diego, 92108 Suite 5 & 23

Call & Speak To A Specialist: (619) 213-4007

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Intake Form

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Intake Form

Schedule Today

Home
About Jaimie
Our Services
The Zen Team
Our Reviews
Contact Us

Client intake Form

Please fill out and submit prior to your appointment

Contact Us

Name

Date

Phone

Email

Referred By:

Instagram

Friend

Walk-in

Other:

Free Text

Hair & Scalp Assessment

Free Text

Scalp Type

Scalp Type

Dry

Oily

Balanced

Sensitive

Flaky

Other

Free Text

Hair Concerns

Hair Concerns

Thinning

Breakage

Dandruff

Product Buildup

Frizz

Heat Damage

Free Text

Recent Treatments (last 4 weeks)

Recent Treatments (last 4 weeks)

Coloring

Perm/Keratine

Bleaching

None

Free Text

Health & Preferences

Allergies/Sensitivities (Title)

Allergies/Sensitivities:

Allergies & Sensitivities

Fragrances

Essential Oils

Nuts

Silicones

None

Medical Conditions (Title)

Medical Conditions

Medical Conditions

Psoriasis

Eczema

Migraines

High Blood Pressure

None

Pressure Preference (Title)

Pressure Preference

Pressure Preference

Light

Medium

Firm

Conversation Level (Title)

Conversation Level

Conversation Level

Quiet Relaxation

Light Chat

Full Conversation

Free Text

Service Goals

What Brings You In Today (Title)

What Brings You In Today

What Brings You In Today

Stress Relief

Scalp Health

Hair Growth

Pampering

Other

Preferred Essential Oil Scents (Title)

Preferred Essential Oil Scents

Preferred Essential Oil Scents

Geranium

Butter Citrus

Cedar Wood

Herbal Mint

Consent & Policies (Title)

Consent & Policies

Consent & Policies

I consent to scalp analysis/photos for treatment purposes.

I understand late arrivals may shorten my service.

I’ve disclosed all relevant health conditions.

Thank you for completing your intake form. We’re honored to be part of your wellness journey. Your responses help us tailor your Japanese Head Spa experience for maximum comfort, care, and relaxation. We look forward to seeing you soon!

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Salon

5171 Mission Center Road,
San Diego, California 92108

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hire@unpluggedheadspa.com

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Client intake Form

Please fill out and submit prior to your appointment

Contact Us

Salon

5171 Mission Center Road, San Diego, California 92108

Instagram

Join Our Team

Grow with us. If you are interested in joining our team, please contact us at:

5171 Mission Center Road,
San Diego, California 92108