Hair Consultation Form
Select a hair service
*
Cut/Style
Full Blonding
Partial Blonding
Root Retouch
Smoothing Treatment
IBE Extension Consult (invisible bead extensions)
Other
Client's Name
*
First Name
Last Name
Client's Phone Number
*
-
Area Code
Phone Number
Client's Email Address
*
example@example.com
Occupation
*
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Upload an image of hair you prefer
*
Browse Files
You can upload multiple files here
Cancel
of
Tell us color history in the last 2 years. Are there any box colors or vivid colors?
*
Upload an image of your current hair and hair inspiration photos.
*
Browse Files
You can upload multiple files here
Cancel
of
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
Other
How long is your hair?
*
Please Select
Short
Medium
Long
Kindly describe the status of your scalp.
*
Please Select
Dry
Normal
Oily
How often do you apply shampoo and conditioner in your hair?
*
Every day
Every other day
Twice a week
Once a week
Other
What is the current condition of your hair?
*
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Normal
Other
Have you use the following in your hair before?
*
Permanent hair color
Keratin Treatment
Razor cut/Thinning
Relaxer
Henna
When did you last visit a hair salon?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
When did you last apply professional or unprofessional color in your hair?
*
Do you have any hair loss problems in the past?
*
Are you currently taking any medications? If yes, please list them below. If not, leave it blank.
Please indicate the list of hair products you're currently using:
How did you hear about us?
*
Facebook
Twitter
Instagram
Google Search
Referred by a friend
Other
Any special instructions, comments, or suggestions?
*
Client Signature
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit
Submit
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