Hair Consultation Form

Hair Consultation Form
Client's Name*

First NameLast Name
Client's Phone Number*
Client's Email Address*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Occupation
Date of Birth*

MonthDayYear
Date
Are you currently taking any medications? If yes, please list them below. If not, leave it blank.
Stylist:*

JanetJackieDebbieTiffanyJersiJennyNatalieMelissaOther
How did you hear about us?

FacebookInstagramYouTubeOnline AdvertisementGoogle SearchReferred by a friendTik TokOther
What service are you scheduled for?
When did you last visit a hair salon? (approx.)
How often do you visit a salon? (ex: every 4 weeks, once or twice a year...)
How often do you use shampoo/conditioner or treatments?

List of current products used:

Hair Characteristics
ShortMediumLongExtra Long
ThinThinningNormalThick
FineNormalCoarse
StraightWavyCurlyCoily
0%5%25%50%75%100%
How would you describe the overall condition of your hair? (check all that apply)

NormalDryColor TreatedDamagedOther
Scalp & Sensitivities (check all that apply)

DandruffDryTender HeadedEczema/PsoriasisAcne/CystsOilySensitive to Chemicals
Daily Routine & Tools: (check all that apply)

Blow DryerCurling IronFlat IronDiffuserAir StylerHot RollersRound BrushOther
Color & Chemical History (past 2 years)
YesNo
If yes, when was your last color or highlight? (approx.)
Brief description of your last service: (Was the service done in-salon or at home?)
Type of color previously used? (check all that apply)

Bleach/LightenerPermanentTemporaryFashion ColorsSemi-PermanentHenna
YesNo
If yes, please describe:
Upload images of your current hair.

You can upload multiple files here
Cancelof
Upload images of any inspiration photos you may have.

You can upload multiple files here
Cancelof
Client Signature*

Clear
Date Signed*

MonthDayYear
Date
Hour MinutesAM/PM Option
Should be Empty: