ONLINE APPOINTMENT REQUEST
Please indicate the date and time you would like to schedule your appointment for. To avoid any possible inconveniences, try to book your appointment 4 days to 1 week in advance of the date and time requested.

Please Note: Required fields are marked this symbol *

*First Name:	*Last Name:
*Email Address:	*Telephone No.:
Address:	Fax No.:
City:
Province:
Postal Code:

ONLINE APPOINTMENT REQUEST Please complete the appointment request 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 Request: 1st Choice* Date: Time: January February March April May June July August September October November December select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 select 9am 10am 11am 12pm 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm 9pm select Appointment Request: 2nd Choice* Date: Time: January February March April May June July August September October November December select 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 select 9am 10am 11am 12pm 1pm 2pm 3pm 4pm 5pm 6pm 7pm 8pm 9pm select Which Capucci Team Member do you prefer for your service? (please select from the menu below): Stylists Technicians Select Stylist GINO TED RINO GIULIANO FRANK ASHLEY BARBARA DEE VERONIKA VINCE Select Technician ATHENA BOUCHRA CLAUDIO HELEN IRENE DIANNE MICHELLE	Please select the service(s) you want from the selection below: Haircut Haircut Consultation Colour or Rinses Colour Consultation Updo Highlites Perms & Perm Consultation Wash & Style Hair Treatments Makeup Hand Treatments Eye Treatments Facial Treatments Foot Treatments Body Treatments Hair Removal
How would you like to be contacted to confirm your appointment?* Telephone Email Fax
GENERAL INFORMATION (please complete the following): If referred, who referred you to Capucci? Is this your first visit to Capucci? yes no     How did you learn about Capucci? 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 Capucci may be in contact with you to confirm your appointment. If you know the name of the name of the Capucci Team Member you would like to attend you, please include that information in your email. To book an appointment by email: blOORWEST@CAPUCCI.COM To book an appointment by phone: (416) 766-3287 Thank you for visiting the Capucci web site.