Existing Guest Consult Form

1

First Name* This field is required.

2

Last Name* This field is required.

3

What are you looking to change?* This field is required.Please select one

4

Please upload a photo of how your hair looks right now* This field is required.Please use a photo that is taken in natural light

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Max. file size: 10.6MB

5

Please list any concerns or troubles you are experiencing with your hair currently.(Examples: Dryness, not styling easily, color fading more than normal, etc.)

6

Please upload a photo of your inspiration* This field is required.

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Max. file size: 10.6MB

7

What do you like about the above inspiration photo?* This field is required.

8

Have you recently started any new medications?* This field is required.Your information is kept confidential.

YESNO

9

If you have, can you please list them below.Your information is kept confidential.

10

Any new allergies since I saw you last?* This field is required.

YESNO

11

If so, can you please list them below.Be sure to include food allergies, as many food ingredients can be in hair products.

12

Have you had Covid in the last 3-6 months?* This field is required.Many experience hair loss anywhere from 2-4 months after having Covid, as well as issues with hair color processing.

YESNO

13

Have you had any major life changes since I saw you last?* This field is required.*i.e. death of a loved one, big move, loss of job, major surgery, recently pregnant etc*

YESNO

14

Are you currently pregnant or breast feeding?* This field is required.

YESNO