Salon Referral Client Information Form

 

USE THIS FORM to inform HRI of your client referral and receive your financial compensation.  Thank you for your involvement!

 

Salon Name:

Stylist Name (first and last):

Salon Telephone:

Choose one of the following:
Stylist gave the customer a brochure.
Stylist did not give the customer a brochure.  HRI should send.

Does HRI have permsssion to contact the client?

  Yes No

Client Name:

Date of Birth:

Street Address:

City, State, Zip:

Primary Phone:

Secondary Phone:

Client Email Address:

Preferred Contact Method:

NOTES:

Any information that may assist us in helping the client make a decision, i.e. is he/she concerned about cost, privacy of consultation, location, etc?

 

 

If you experience any problems using this form, please let us know by calling or email is at the number and address listed below.

 

 

Hair Restoration Institute of Minnesota  -  Serving you since 1982.
Toll Free: 888-241-3258 - Email: info@hrimn.com

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8030 Old Cedar Avenue South, Bloomington Minnesota 55425 - Tel. (612) 588-HAIR (4247)
2598 Rice Street, St. Paul Minnesota 55113 - Tel. (612) 588-HAIR (4247)