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Online Consultation Form (New Client)
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40
Questions
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1
Name
*
This field is required.
Please enter your full name
First Name
Last Name
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2
Date of Birth
*
This field is required.
Please enter your date of birth
.
Date of birth
Day
Month
Year
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3
Email
*
This field is required.
This is where we will be in touch - please ensure that your email address is typed correctly
example@example.com
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4
Phone Number
*
This field is required.
Mobile Number
Please enter a valid phone number.
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5
Have you ever had a hair color, root touchup, toning, or glossing services at Hina Y Salon?
*
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YES
NO
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6
What is your profession?
*
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7
Preferred Date of Hair Color Appointment
*
This field is required.
By what date would you prefer to have your hair color done? Please note that we may not be able to accommodate urgent requests, as we are booked in advance.
.
Date
Day
Month
Year
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8
Where do you currently live?
*
This field is required.
Please let us know your permanent city and country of residence so we can help you with maintaining your color (if need be)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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9
Do you have any medical/hormonal conditions?
*
This field is required.
Please note that all information provided by you on this form is confidential.
YES
NO
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10
Please mention the medical condition(s) you have
*
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11
Have you taken any medication in the last 6 months?
*
This field is required.
YES
NO
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12
Please provide names of all medication taken
*
This field is required.
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13
Have you ever had any allergic reactions to products applied to your scalp/skin?
*
This field is required.
YES
NO
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14
Please provide details
*
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15
Are you pregnant or breastfeeding?
*
This field is required.
YES
NO
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16
The next question will require you to add photos of your hair. Please use these images below as a guideline of the types of photos we are looking for as well as the areas of your hair we need to see. For best results, please have someone take the pictures for you. NOTE: Unclear pictures will not allow us to respond properly and will result in no form response.
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17
Please add clear photos of your hair below (do ensure that they are taken in a well-lit environment). We have added example photos in the previous slide. You can add up to 10 photos. For best results, please have someone take the pictures for you. NOTE: Unclear pictures will not allow us to respond properly and will result in no form response. Please make sure that the hair is in the texture that you mostly keep it in.
*
This field is required.
Minimum: 5 photos
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18
Please select all of the following options that apply to your hair from the last FIVE (5) years. Make sure to carefully think back on what applies to your hair in this time period
*
This field is required.
Hair dye
Base change
Root touchup
Box dye
Highlights/Lo-lights
Balayage
Ombre
Keratin Treatment/Chi Enviro
Hair botox/Brazilian Blowout
Rebonding/Relaxing/Perm
Xtenso/Chi Transformation
Henna
Natural/Organic Hair Dye
Glossing/Toning
Other
Never applied any of the above
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19
Please list the service/product used
*
This field is required.
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20
Now, select all of the following options that apply to your hair from the last TWO (2) years. Make sure to carefully think back on what applies to your hair in this time period
*
This field is required.
Hair dye
Base change
Root touchup
Box dye
Highlights/Lo-lights
Balayage
Ombre
Keratin Treatment/Chi Enviro
Hair botox/Brazilian Blowout
Rebonding/Relaxing/Perm
Xtenso/Chi Transformation
Henna
Natural/Organic Hair Dye
Glossing/Toning
Other
Never applied any of the above
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21
Please list the service/product used
*
This field is required.
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22
Select an image from the following that best describes your natural hair texture
*
This field is required.
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23
Please list the products you currently use for your hair (shampoo, conditioner, leave-in products, salon treatments, etc). Do ensure that you list brand names as well as product line names where applicable.
*
This field is required.
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24
Do you have any grey hair?
*
This field is required.
YES
NO
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25
When we color your hair, what would you like us to do with your grey hair?
*
This field is required.
Cover it up
Camouflage/blend it with highlights
Nothing. I don't mind my grey hair
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26
Is your hair falling or thinning?
*
This field is required.
YES
NO
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27
How often do you wash (shampoo and/or condition) your hair?
*
This field is required.
Less than once a week
Once a week
2-3 times a week
Daily
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28
Do you notice thinning on the crown area (top of the head) or thinning at the temples?
*
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YES
NO
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29
How often do you use heat-styling tools (like a hair dryer, straightening iron, curling wands, etc)?
*
This field is required.
Less than once a month
Once a month
Once a week
Twice a week
Every time I wash my hair
Never
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30
Tell us what you like and what you dislike about your hair.
*
This field is required.
Likes
Dislikes
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31
What is the reason you are coloring your hair (select all that apply)?
*
This field is required.
Grey hair
Bored of my current look
My color needs to be fixed
Hair looks dull
I have an event coming up
I don't like what I currently have
Other
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32
Please mention the reason you are looking to change your hair color.
*
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33
On a scale of 1 to 10, select how much of a change or transformation you are looking to achieve (1 being the smallest amount of change and 10 being a major transformation).
*
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34
Add 3 photos of hair color that you LIKE. This will give us a better understanding of your taste (we recommend looking through our Facebook and Instagram pages to help you understand the kind of work we like to create).
*
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35
Add 3 photos of hair color that you DISLIKE. This will give us a better understanding of your taste (we recommend looking through our Facebook and Instagram pages to help you understand the kind of work we like to create).
*
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36
What is your budget for your hair color?
*
This field is required.
Under Rs 10,000
Rs 12,000 - Rs 15,000
Rs 15,000 - Rs 20,000
Rs 20,000 - Rs 30,000
I do not have a budget, I am willing to spend as long as I get what I want
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37
Every hair color technique has its own required maintenance to ensure it looks great, even when it's not brand new any longer. How often are you willing to come in for small maintenance services like toning/glossing, root touchups, and/or other short services (below 1.5 hours).
*
This field is required.
Monthly
Once in 2-3 months
Once in 3-6 months
Once a year
I do not live here, so I am not sure how to maintain my color once I have it done
I just want to color it once and then grow it out without maintenance
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38
Are you looking to get a haircut with your hair color service as well?
*
This field is required.
YES
NO
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39
Which of the following best describes your personal style?
*
This field is required.
Casual, Comfortable, Simple, Easy
Professional, Refined, Polished, Timeless
Bold, Striking, Strong, Attention Grabbing
Gentle, Soft, Pretty, Girly
Sporty, Functional, Active Wear, Beachy
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40
Please write down any concerns or requests that you have about your hair coloring service.
*
This field is required.
This is where you can mention anything that we haven't asked in the form
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Online Consultation Form (New Client)
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