Name *

First Name

Last Name

Phone Number *

(###)

###

####

Best way to reach you? *

Email

Call

Text

New Client? *

Have you seen Melissa before?

Yes

No

Please enter the date range below in which you are looking to book an appointment. *

From this date:

MM

DD

YYYY

*

To this date:

MM

DD

YYYY

What days of the week are you available? *

Select all that apply

Tuesday Morning

Tuesday Afternoon

Tuesday Evening

Wednesday Morning

Wednesday Afternoon

Wednesday Evening

Friday Morning

Friday Afternoon

Friday Evening

Saturday Morning

Saturday Afternoon

My Schedule Is Flexible

My Schedule Varies

Would you like to be added to the cancellation list for the other Dime stylists as well? *

Yes

No

*

This form does not guarantee you an appointment, I will be in touch if something opens up during your requested date range.

I Understand