Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Birthdate

MM

DD

YYYY

If you are looking for a dramatic change, your service provider may require a virtual conversation. Would you be willing to Face Time or Zoom?

No changes this time.

Yes please!

No thank you.

I will send photos of my hair and hair goals in this form.

Not sure yet.

Have you colored your hair in the past 12 months? *

Yes (professional)

Yes (at home/box color)

No

Have you ever had any of the following? (Check all that apply) *

Highlights/balayage

Keratin/smoothing treatment

Relaxer/chemical straightening

Perm or texturizer

Extensions

None

Are you open to trying new things? *

Yes

No

Do you want a new look at every salon visit? *

Yes

No

How much time do you typically spend on your hair? *

5 Minutes

15 Minutes

30 Minutes

1 Hour

What is your current hair length? *

Short (above chin)

Medium (shoulders)

Long (past shoulders)

Abundance: *

Sparse

Average

Thick

Condition: *

Dry

Distressed

Porous

Diameter: *

Fine

Medium

Coarse

Formation: *

Straight

Wavy

Springy

Spiral

Face shape: *

Square

Circle

Oblong

Oval

Diamond

Triangle

Inverted triangle