Color Lounge Intake Form

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Name
First Name
Last Name
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Email
example@example.com
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Cell Phone Number
Please enter a valid cell phone number.
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Birth Date
Birth Date
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Adult
Teen
Child
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Are you a New Client?
YESNO
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Where did you hear about us?
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Length of Hair
Short - chin length & above
Medium - past chin to shoulder length
Long - past shoulder length & more
Extra Long - past bra strap
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Hair Density
Very Thin
Thin
Normal
Thick
Extra Thick
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Hair Texture
Fine
Medium
Coarse
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Hair Pattern
Straight
Wavy
Curly
Kinky
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Describe your Scalp
Dry
Normal
Oily
Dandruff
Psoriasis
Ezcema
Dermatitis
Scalp Issues
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If you have any scalp issues, skin conditions, or allergies please list/ describe.Certain scalp conditions may affect our ability to do a hair service. If this is a concern, please see a doctor. We will require a doctor's note prior to booking.
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For color clients only: What is the natural color growing out from your scalp?Choose from Level 1-8 + % of Gray. Please check all that apply.
Level 1 (Black)
Level 2 (Darkest Brown)
Level 3 (Dark Brown)
Level 4 (Brown)
Level 5 (Light Brown)
Level 6 (Dark Blonde)
Level 7 (Blonde)
Level 8 (Light Blonde)
25% Gray
50% Gray
75% Gray
White
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For color clients only: If your hair has been previously colored, please check all the colors that is in your hair minus your root color.
Level 1 (Black)
Level 2 (Darkest Brown)
Level 3 (Dark Brown)
Level 4 (Brown)
Level 5 (Light Brown)
Level 6 (Dark Blonde)
Level 7 (Blonde)
Level 8 (Light Blonde)
Level 9 (Very Light Blonde)
Level 10 (Lightest Blonde)
Strawberry Blonde
Dark Auburn
Copper
Light Auburn
Burgundy
Red
Natural looking Gray/Silver Hair Color
Artificial Gray/Silver Hair Color
Artificial Vivid Hair Color(s)
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For color clients only: Approximately how long is your natural roots? Give your best estimate.Note that a root touch up can be no more than 1 inch.
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For color clients only: Please select what most likely resembles your current hair situation.Please select all that apply.
Virgin Natural Hair (Untouched)
Permanent Hair Color
Previously Bleached Hair
Demi Permanent Hair Color
Semi Permanent Hair Color
Henna
1 Base Color
Highlights
Base Color with Highlights
Base Color with Highlights/Lowlights
Balayage
Blonde Balayage
1 Solid Blonde
Platinum Blonde
Silver/Gray Hair Color
Artificial Vivid Hair Color(s)
Overtone/Viral/Other Color Deposit Shampoos/Conditioners
Hair Extensions
Brazilian Blow Out
Keratin Treatment
Chemical Straightener
Perm
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Service(s) DesiredPlease check off the boxes that apply. (See description of services under the services tab on our website.)
Consultation [recommended for first time clients] - 30m-60m ($30-$60)
Virtual Consultation - 30m-60m ($30-$60)
Hair Extensions Consultation - 30m ($30)
Strand Test ($45)
Patch Test ($25)
Barber Cut ($70+)
Haircut ($75-$150+)
Curly Haircut ($150+)
Pixie/Short Haircut ($150)
Base Color Root Touch Up (no more than 1 inch) ($125-$150+)
Standard Full Color (Roots/ Refresh) (current color refreshed from roots to ends or for going 1-3 shades darker only. No bleaching) ($175-$200+)
Detailed Color Glaze ($125-$150)
Full Color [Going Darker] - involves Pre-pigmentation - approx 3.5-4 hrs+ ($350 + then hourly @ $100-$150/hr)
Partial Custom Color - approx 3.5hrs+ ($350 + then hourly @ $100-$150/hr)
Half Head Custom Color - approx 4hrs+ ($400 + then hourly @ $100-$150/hr)
Full Head Custom Color - approx 5hrs+ ($500 + then hourly @ $100-$150/hr)
Blonding Project - approx 6hrs+ ($600 + then hourly @ $100-$150/hr)
Creative/ Vivid Hair Color Project - approx 6hrs+ ($600 + then hourly @ $100-$150/hr)
Going Gray Transition - approx 8 hrs+ (starting at $1,600 Day Rate + then Hourly @ $200/hr)
Hair Color Correction - time varies ($100-$150/hr)
Hair Extensions Hair (MKT Price)
Hair Extension Application/Removal/Maintenance - approx 3 hrs+ ($150/hr)
Brazilian Blow Out - approx 2.5-3.5 hrs ($100-$150/hr)
Vitamin C Detox Treatment - 15m-45m ($45-$65)
Scalp Treatment ($65-$165)
Express Hair Treatment $25)
Luxury (Moisture or Bond) Treatment ($55)
Shampoo Blow Dry ($50-$75)
Additional Curls/Flat Iron ($25 per 15min)
Event Hair ($150)
Event Make Up $125)
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Service(s) desired (description)
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For color clients only: If the service desired is hair color, what is the color(s) you wish to achieve? Choose all colors that apply.
Level 1 (Black)
Levle 2 (Darkest Brown)
Level 3 (Dark Brown)
Level 4 (Brown)
Level 5 (Light Brown)
Level 6 (Dark Blonde)
Level 7 (Blonde)
Level 8 (Light Blonde)
Level 9 (Very Light Blonde)
Level 10 (Lightest Blonde)
Strawberry Blonde
Dark Auburn
Copper
Light Auburn
Burgundy
Red
Natural looking Gray/Silver Hair Color
Artificial Gray/Silver Hair Color
Artificial Vivid Hair Color(s)
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For color clients only: Do you prefer Warm Tones, Cool Tones, or Neutral tones?
Warm Tones (Gold, Copper Gold, Copper, Reds)
Cool Tones (Blue, Violet, Ash)
Neutral (Beige, Browns, colors that are neither too warm or too cool)
Prefer my stylist to choose
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Please upload your current hair picture.You may upload different angles of your hair.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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Please Upload your Desired Hair Pictures
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
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If your pictures need a description, please state it here so we can better guide you to what service(s) you will need to achieve your desired hairstyle/color.
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Availability Our hours of operation are from Wed-Sat 10am-7pm. Please list some dates/times you are available to make your appointment.
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What is the best way to reach you?Business Hours are from Wed-Sat 10am-7pm. Please allow for us 24-48 hours to respond to your request.
Call
Text
Email
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Opting Into Color Lounge Inc. Text Communications: To comply with SMS texting regulations, we require your consent to communicate with you via text messages. By opting in, you agree to receive texts regarding appointment confirmations, reminders, service updates, and occasional promotions. Message frequency may vary. Message and data rates may apply. To opt in, please reply with your consent by clicking YES when contacted or request to be added to our text messaging list. To opt out at any time, reply STOP, CANCEL, or UNSUBSCRIBE. For assistance, reply with HELP, contact us at info@colorlounge.com or visit colorlounge.com/privacy-policy to l earn more.
YESNO
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*DEPOSIT REQUIRED TO RESERVE AN APPOINTMENT*

You will be prompted to make a deposit after reviewing your intake form to make a reservation.

Security Deposit: Security deposit is non-refundable if cancelled, rescheduled, or No Show within 48 hours. No exceptions.

Security deposit is refundable if cancelled prior to 48 hours of appointment.
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