Head spa intake form: hair history, a health check and the scalp treatment plan
A head spa looks like the calmest service on your menu. But your client is lying back, with oils and fragrance close to their face, and sometimes steam, light or a gentle current on their scalp. The intake is where you find out what changes that plan, before anyone lies down.
This exact form is built into SlickChart: send it to your client's phone to fill in before the first visit, and the scalp analysis plan saves to their chart.
Start with what they are booking
After the contact basics, my intake goes straight to the service. They check what they are booking: signature ritual, exfoliation and cleanse, steam and hydration, hot oil and massage, high-frequency scalp, LED light therapy, neck and shoulders, or a blow-dry.
The concern list covers itching, flaking, oiliness, dryness, buildup, sensitivity, thinning, breakage, tension headaches and stress. An open box asks what they would love to feel or notice after their visits, and anything they would like you to avoid. A quick pick sets massage pressure.
Hair history changes your timing
Ten checkboxes cover what their hair has been through: color, gloss or toner, lightening or bleach, relaxer or perm, keratin or smoothing, extensions, weave or wig, heat styling most days, hats or helmets often, tight braids or ponytails, dry shampoo often, and swimming in chlorine.
A text box asks for the last date of any color, lightening, relaxer, perm, keratin or extensions. Then a plain yes or no: any of those chemical services in the last 72 hours? That answer matters because my studio policy allows 72 hours between color or other chemical services and exfoliation, steam or high frequency. Better to catch it on the intake than at the bowl.
Two short fields ask how often they wash and what products they use now.
Four quick lifestyle picks
Sleep, stress on a 1 to 10 scale, screen time and water, each a single tap. They are context for the conversation, not a diagnosis.
Allergies, before any oil is opened
The allergy list is written for head spa products: fragrance, essential oils, nut oils such as almond and argan, botanicals or plant extracts, latex, hair dye or PPD, salicylic acid or aspirin, and shampoo or scalp products, with "none that I know of" as an option. A short box asks what reaction they had, and to what.
If anything is checked, my separate sensitivity and patch test record goes deeper. New products are patch tested behind the ear and checked at 24 and 48 hours, and the record says plainly that a patch test lowers risk but cannot rule out a reaction. Formal allergy testing belongs to a dermatologist.
A health check built for lying back
The health section says up front that some answers mean a gentler service or a doctor's OK first. Sixteen items follow. Scalp items: psoriasis or eczema on the scalp, face or neck, a seborrheic dermatitis or dandruff flare, lice or ringworm in the last 30 days, folliculitis, sores, cuts or scabs, and hair loss diagnosed by a doctor. Then recent work: surgery or a hair transplant in the past 12 months, Botox or fillers in the last 2 weeks, and medicine that makes skin light-sensitive.
The rest are about the position and the devices: neck or spine problems, vertigo or feeling dizzy at a shampoo bowl before, a stroke or mini-stroke ever, high blood pressure or a heart condition, a pacemaker or metal implant in the head or neck, epilepsy, seizures or migraines, pregnancy, and any other medical condition. A box below asks for every medication, including supplements.
A check starts a conversation. What a scalp condition is, or whether hair loss needs treatment, is for a dermatologist to say.
What they agree to
Short acknowledgements close the intake. Their answers are true and complete, and they will tell you about changes. Head spa services are relaxing and cosmetic, not medical, and no result is promised, including hair regrowth. They will speak up if they feel dizzy, numb or uncomfortable, and can stop at any time. Reactions can happen, even to familiar products. A privacy note says records are kept confidential for 7 years.
The scalp analysis and treatment plan
After the camera analysis, my second form is yours to fill in: the client's main concerns today, recommended services, frequency, the next visit and re-analysis, and home care and products. Then the client signs it:
I've seen my images and agree to this plan. Head spa care is cosmetic; regrowth isn't promised.
My pre-visit guide explains it the same way: a small camera shows the scalp up close, the same 4 to 6 zones are photographed to track progress, and it is not a diagnosis.
Questions to decide for your own practice
- Which services need their own consent on top of the intake? My head spa consent form post covers the ritual, and scalp exfoliation consent covers deeper cleansing.
- Shampooing and blow-drying are offered only where a license allows, and rules on devices such as high frequency and LED vary. Check your state board's rules on licensing and devices. This post is not legal or medical advice.
The full set of forms and guides is on my head spa forms page.
Use this form with your clients
SlickChart has this exact head spa intake and scalp analysis plan built in for subscribers. The form goes to the client's phone to fill in before the visit, or they complete it on your device in the room, and any health item they check is flagged for you. Aftercare lands in the client's own app, styled with your logo, and it all works alongside the Square account you already have. If that would save you paperwork, try SlickChart.
Prefer paper? The printable head spa set, with this intake, the scalp analysis plan and the aftercare, is in my Etsy shop, ready to print or edit in free Canva.