Shaylee L Appointment Request

1

Name* This field is required.

First Name

Last Name

2

Phone Number* This field is required.

Please enter a valid phone number.

3

Email* This field is required.

example@example.com

4

Referred byClient Name

Other: social media, google search, drive by, square

5

Gender

Female

Male

Nonbinary

6

Service Type* This field is required.Please select one

7

Date of your previous color?

8

Within the last 6 months, do you have any of the following?* This field is required.Please check all that apply

Gray hair

Permanent color on your hair

Box dyed hair

Reoccurring scalp conditions

Extensions

Suffered major hair loss

None of these apply

11

Pictures of your current hair- FRONT VIEW upload* This field is required.No filter, no selfies & natural lighting with hair down

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

12

Pictures of your current hair- BACK VIEW upload* This field is required.No filter, no selfies & natural lighting with hair down

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

13

Hair Goals* This field is required.Upload HAIR INSPO pictures of your ultimate dream hair! What inspired you and what goals do you have for your color?

Drag and drop files here

Select files to upload

Max. file size: 10.6MB