First Name
*
Last Name
*
Date of birth
*
Phone
*
Email
*
Instagram Handle
My Hair is...
*
Short
Medium
Long
My hair is...
*
Fine
Medium
Thick
What level of hair maintenance are you comfortable with?
*
3-4 weeks
6-8 weeks
10-12 weeks
Twice a year
Once a year
Has your hair been chemically processed?
*
Yes
No, I have virgin hair
Have you had any of the following on your hair? Please answer honestly
*
Professional Permanent hair color
Sun In
Box Color or Sally's Color
Relaxer
Henna
None
Describe any problem areas or issues you have with your hair (ex. breakage, frizz, dry scalp, hair loss, etc)
Please list any allergies or skin sensitivities - if none leave blank
Would you prefer a silent appointment? no small talk or conversation other than important/need-to-know information
Yes
No
Please provide a picture of your current hair
Please provide your inspiration picture(s) here
Any special instructions, comments, or suggestions?
Signature
*
Clear
Date
*
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