State of Mind Pre-Consultation Guide
State of Mind Salon & Day Spa, 111 West 94th Place, Crown Point, IN 46307
Guest's Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Date
Guest's Phone Number
Format: (000) 000-0000.
Guest's Email Address
example@example.com
Please choose which color services best describe your dream look:
Custom color (color correction)
All over color (going darker all over, one color)
Blended service/Balayage (has dimension, a lived in look)
Highlights (traditional highlighting to the scalp/root)
Glaze (toner)
Specialty color (vivid color)
Double process (going lighter from scalp to ends)
Ombre (color melt going from dark to light with no dimension)
Touch up (roots only, no bleaching just color)
Other
Upload an image of the hair color you prefer:
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Upload 3 images of your current hair: top, back, and side:
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How much time do you spend on your hair daily?
Less than 30 minutes
More than 30 minutes
What is the current condition of your hair?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Other
Color History- In the last 2 Years- which of the following have you had done?
Dark to Light
Light to Dark
Colored at Salon
Colored at Home
NONE
How often do you apply shampoo and conditioner in your hair?
Every day
Every other day
Twice a week
Once a week
Other
Are you planning on getting a haircut, and if so is it a drastic change from your current hair style?
How soon would you like to visit us and what does your availability look like?
*
How much time are you expecting to spend in the salon to achieve your desired look?
*
Less than 3 hours (only one visit)
Less than 3 hours (okay with multiple visits)
3+ hours at one visit
How did you hear about us?
Facebook
Instagram
Google Search
Referred by family or a friend
Newspaper/Magazine
Other
If you were referred by family or a friend, please let us know their name below so we can make sure to thank them!
Any special instructions, comments, or suggestions?
Date Completed Form
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Month
-
Day
Year
Date
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