Client's Name
First Name
Last Name
Client's Phone Number
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Area Code
Phone Number
Client's Email Address
example@example.com
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Upload an image of your current hair
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How often do you go to salon for hair treatment?
Every week
Every 2 weeks
Every 3-4 weeks
Every 2 months
Every 2-6 months
Twice a year
Once a year
What is the current condition of your hair?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
How often do you apply shampoo and conditioner in your hair?
Every day
Every other day
Twice a week
Once a week
What is your hair color history? (Professional color? At home color? How often)
How did you hear about us?
Facebook
Twitter
Instagram
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Any special instructions, comments, or suggestions?
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