Client's Name
First Name
Last Name
Date of Birth
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Month
-
Day
Year
Date
Client's Phone Number
-
Area Code
Phone Number
Client's Email Address
example@example.com
Occupation
Select a hair service you are looking for suggestions on:
Haircuts
Hair Colour (Permanent)
Hair Colour (Semi)
Hair Colour Blending
Hair Conditioning
Hair styling (Formal)
Hair Styling
Foils
Other
Upload an image of your current hair
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Upload an image of hair style or hair colour you want to achieve
Browse Files
You can upload multiple files here
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What would you change or improve about your hair?
What do you love about your hair?
Length
Colour
Texture
Other
Do you have any allergies or medical Conditions I should be aware of?
Have you had a previous experience of blistering, inflammation or hair loss after a hairdressing service was performed on you?
What is the current condition of your hair?
Hair loss
Heat Damage
Split ends
Breakage
Itchy scalp
Dry hair/scalp
Dandruff
Sensitive scalp
Colour fading
Fine hair
Grey hair
Oily hair/scalp
Healthy
A sudden change in hair/scalp
Other
How often do you apply Shampoo and Conditioner in your hair?
Every day
Every other day
Twice a week
Once a week
Other
Have you had the following services applied to your hair in the past?
Semi/ Permanent hair colour
Keratin Treatment
Relaxer
Henna
Lightener/ Bleach
How much time do you dedicate to styling your hair every morning?
less than 5mins
30mins plus
less than 15mins
Other
How do you Preferer to purchase your home haircare?
salon
supermarket
online
other
Kindly list the hair styling products that you are currently using.
What are the tools you are using to style your hair?
How did you hear about us?
Facebook
Instagram
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Other
What are your listening preferences? *if you have particular requests comment below
Podcast
Playlist
Your own headphones
Natural Surroundings
Other
Any special instructions, comments, requests or suggestions?
Client's Signature
Date Signed
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Month
-
Day
Year
Date
Submit
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