Captiva Hair Design

Online Booking

SECTION [A] - PERSONAL DETAILS
*First Name:	Last Name:

Email Address:	*Telephone No.:

Address:	Fax No.:
(line 1) (line 2)
City:	Postal Code:	Province:

SECTION [B] - APPOINTMENT DETAILS

APPOINTMENT INFORMATION
Please complete the appointment form, when you are finished, please click the submitt button. You will receive a confirmation of your appointment by one of our team members. Thank you!

Appointment: (1st Choice)*
Date:		Time:

Appointment: (2nd Choice)*
Date:		Time:

Which Captiva Team Member do you prefer for your service?
(please select from the menu below):

Stylist/Colorist	Esthetician

How would you like to be contacted to confirm your appointment?*

Telephone

Fax

Please select the service(s) you want from the selection below:

	Haircut			Makeup :
	Color or Rinses			30 Bridal
	Updo			Massage :
	Highlites			Relaxation Massage (1/2 hour)
	Highlites & Color			Relaxation Massage (1 hour)
	Perms & Perm Consultation			Neck/Shoulder/Back (15 min)
	Wash & Style			Tinting :
	Hair Treatments			Eyelashes
	Facial :			Brows
	European			Eyelashes & Brows
	Back			Hair Removal :
	Aromatherapy			Face(lip/chin/sides)
	Electrolysis :			Upper Lip
	Electrolysis (1/2 hour session)			Underarms
	Electrolysis (1hour session)			Chin
	Eyebrows :			Tummy
	Tweezing			Back
	Brow Wax			Buttocks
	Hands :			1/2 Leg (bottom)
	Mini-Manicure			Upper Legs
	Full European Manicure			Full Leg Wax with Bikini
	Manicure & Paraffin			Bikini Line
	French Manicure			Bikini Plus
	Nail Mend			Arm (Full)
	Man's Manicure			Arm (Half)
	Feet :			Brazilian
	Spa Pedicure
	Men's Pedicure
	European Pedicure
	Mini Pedicure
	Pedicure with Paraffin

Note : The appointment details of your choice is subject to the availability. We will try our best to give you your choice of date and time. In that case, someone from Captiva will definitely get in touch with you regarding the confirmation of the appointment. Thankyou once again.

SECTION [C] - GENERAL DETAILS

Please complete the following :

If referred, who referred you to Captiva?

Is this your first visit to Captiva?
	yes	no

How did you learn about Captiva?
	Found On Web
	Radio
	Email
	Magazine/Newspaper
	Word of Mouth
Other, Please specify:

Comments?

Note: "If you fail to get an acceptance message, please email us directly". In the body of your email, please include your name, and a telephone number where you can be reached during the day. If you are a new client, someone from Captiva may be in contact with you to confirm your appointment.

If you know the name of the name of the Captiva Team Member you would like to attend you, please include that information in your email.

To book an appointment by email: info@captivahair.com
To book an appointment by phone: 905-277-2321

Thank you for visiting the Captiva web site.