Haircare Consultation Form
By Dee Pompey
Name
First Name
Last Name
How would you like to be contacted?
Instagram
Facebook
Email
Text
Please fill out the ONE option you chose above
I.e your Instagram handle
What goals do you have for your hair? (multiple choice)
Smooth and silky
Growth
Frizz control
Voluminous
What is your hair type?
Curly
Straight
Wavy
How would you describe the thickness of your hair?
Fine to medium
Medium to thick
Thick
What is your hair condition?
Oily
Dry
Normal
What are your hair concerns?
Frizzy and Rebellious
Dry
Damaged and split ends
Other
What chemical services have you had in the last 6-12 months?
Bleached/lightened
Keratin treatment
Chemical straightening
Coloured
Permed
How often do you use heat to style your hair (straightener, blow dryer etc)
1 - 2 times a week
3 - 4 times a week
Every day
Only for occasions
What products are you currently using?
Do you have any allergies?
How much would you like to spend on Hair Care?
$150
$150 - $300
$300+
If you are wanting a Sample, please provide your postal address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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