Consultation Request Form
Please, take a moment to fill out the questionnaire below. This data gives our stylists the insight to receive the highest quality of services. For any questions please do not hesitate to call. Your stylist will contact you prior to your appointment to discus your questionnaire. Thank you!
I have... (Select all that apply)
Naturally curly
Hair color (salon)
Bleached/ Highlighted hair
Permed Hair
Natural straight hair
Scalp: Dandruff or eczema
Hair loss/ thinning
Combonation hair
Naturally wavy hair
"Virgin hair" Never colored
Extensions or wigs
Dry and itchy skin
Relaxed/ straightened/ keratin/ chemically smoothed hair
Heat damaged
Boxed color
What concerns do you have about your hairs health?
Which do you have the following of?
Well water
Town water
Soft or softened water
Chlorinated water
Are you currently taking medication for blood pressure, thyroid, Diabetes or other conditions?
Do you have any allergies we should be aware of?
Do you currently take any supplements, natural herbs or vitamins?
What would you like to learn during your visit
Revive your hairs health and texture
Ways to improve you hairs thickness, strength, and condition
Technniques of the latest styling trends
Knowledge of products that are free of toxic ingredients
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Full Name
*
First Name
Last Name
Phone
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Area Code
Phone Number
E-mail
*
What day approximately are you looking to book?
*
Tuesday
Wednesday
Thursday
Friday
Saturday
What time approximately are you looking for?
*
Morning
Afternoon
Evening
What date are you approximately looking for?
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Month
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Day
Year
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Hour
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Minutes
AM
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AM/PM Option
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