Hair Consultation + Waiver Form
Select a hair service
Haircut
Hair Color (permanent)
Hair Color (highlight)
Hair Color (color correction)
Shampoo + Blowout
Hair Styling (Formal)
Deep Conditioning/Repairing Treatment
Extensions
Vivid/Fashion Color
Other
Client's Name
First Name
Last Name
Client's Phone Number
Client's Email Address
example@example.com
Occupation
Date of Birth
-
Month
-
Day
Year
Date
Tell us your hair color history for the past FIVE years.
Upload THREE images of dream hair. (Inspiration photos)
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
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Upload THREE images of your current hair.
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
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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 wash 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/color
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Other
Have you used the following in your hair before?
Permanent hair color
Keratin Treatment
Highlights (blonde/bleach)
Relaxer
Henna
Perm
Other
When did you last visit a hair salon?
-
Month
-
Day
Year
Date
When did you last apply professional or unprofessional color/chemical treatment on your hair?
Pregnancy hormones can affect the way your hair processes hair color. Are you currently pregnant or have you been in the past year?
Yes
No
Hormone and thyroid medications can alter the way your hair processes hair color. Are you currently taking any medications for hormones or thyroid? 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
Instagram
TikTok
Google Search
Referred by a friend
Other
Any special instructions, comments, or suggestions?
Client Signature
Date Signed
-
Month
-
Day
Year
Date
Print Form
Submit
Submit
Should be Empty: