Consultation form

Consultation form
About your stylist Sharlena Bell Sharlena Bell, a native of Waco, TX is a Master Hairstylist and the proud owner of Pure and Healthy Hair Salon and own product line Better Curl Days.Her relationship with God, her love of family, and her passion for healthy hair are the keystones of her life. She has been doing what she loves, helping her clients maintain healthy beautiful hair since 1994, and has been working her magic in the greater Dallas Fort Worth area for the past 23 years. Sharlena combines her faith in God, her passion for healthy hair, and her years of knowledge and experience to provide each client with an unrivaled healthy hair care experience that is both professional and personalized. Her passion for hair wakes her up every day. She is motivated by the journey each strand offers and lives to help every client find their path to a lively, lustrous head of hair. She adores the look and feel of healthy hair and is inspired by the smile her clients give when they experience that lovely, beautiful hair feeling.Sharlena specializes in natural hair and hair color however, her dedication to providing the best hair care available to a diverse clientele has led her to take countless hours of educational classes, seminars, shows, and attend other highly regarded events across the US. She has been awarded several certificates and accreditations for products and services using the latest technology and techniques available today. Sharlena is a certified technician in:Better Curl Days Brazilian BlowoutsColora color PhytospecificToni & Guy advance cuttingRedken exchange (Color and Know Why) Socap Hair extensions Babe extensions Dreamcatchers Miss Jessies, Prime Pro Haircare Prime Pro Professional National EducatorHer vast knowledge and experiences have led her to service her clients using only the best products and equipment, and when she couldn’t find the right products for her curly clients, she created her line, “Better Curl Days”. Not only does she use the products for herself and her clients; she has also made the product line available to all via her digital shop at pureandhealthyhair.net. Now, everyone can achieve beautiful, bouncy, shiny, and of course healthy curly hair.Sharlena has always lived her life under the belief that she can do all things through God, and recently she has been on a mission to share her passion for healthy hair. She enjoys teaching other stylists how to better care for their client’s hair and helping individuals understand how to better care for their own hair. She takes pride in using her wealth of knowledge and experience to inspire individuals and help develop eager stylists like her daughter Malaysia, into Healthy Hair Masters. Looking forward to the future she aims to build a legacy focused on educating the masses on how to properly care for hair in the salon and at home.
Customer Details:
Full Name*

First NameLast Name
City and state
Phone Number*
E-mail
example@example.com
Birthdate ( you receive a birthday discount on your birthday month)

MonthDayYear
Date
Your age
Your profession . Do you work from home? yes or no
Tell us a little bit about your lifestyle

Leggings is my jamTravel proLaid-back no fuss lifestyle that’s me!edgy and fashionista
How often do you work out and sweat?

Weekly2 to 3 times a weekNeverHot flashes
What do you love about your hair?
What are some things you would like to change about your hair?
hair texture

FineMediumCourse
What is your curl type?*
What is the condition of your hair?

HealthyDamaged
Hair issues you may have.

BreakageDrynessOilyThinningBald spotsMissing Edges
Percentage of gray
Condition of hair

RelaxedColor treatedSmoothing treatmentNone of the above
Scalp condition

DryFlakyPsoriasisSerberec dermatitisOilyItchyNormalSensitive scalp
How often do you shampoo and condition your hair?
How often do you trim your hair?
When was your last trim?
What’s three styles do you wear the most?
Color services you’ve had performed in the last 2 years

Semi permanent rinse are temporary colorDemi permanent colorPermanent colorBleach or highlightsBlack or brown colorBeijing black color
Are you allergic to any chemicals for example color or smoothing treatments?
What is your desired color?
Do you perform chemical services at home yourself? yes or no
Which styles do you prefer?

BraidsExtensionsProtective stylesWigsSilk pressWashing goNatural Curly styleBlow dry straightFlat twist or two strand twist
Curlies Only how often do you Straighten your hair?

NeverOnce a monthTwice a monthOnce a year
Have you had a curly cut before?*

YesNo
Do you want to wear your hair 100% of the time?*
Please follow Curly Cut instructions for a Curly CUT
How often do you shampoo and condition your hair?

WeekBiweeklyOnce a month
How often do you deep condition your hair with treatments or mask?

WeeklyBiweeklyMonthlyEvery six weeksNever
Where are you most likely to purchase your HairCare products?
Name the current product you’re using?
Have you received any kind of smoothing treatments or keratin treatments in the last year?

YesNoNot sure
When was your last salon visit?
How often do you come to the salon?

Every weekEvery two weeksmonthlyEvery 2 to 4 monthsTwice a yearOnce a year
What is your budget for a salon visits and product purchases monthly?
What are you hoping to achieve at your hair appointment? What a year expectations for your new stylist.
Is there anything I need to know about your health that may affect your hair journey, for example, medication, weight, loss, surgery, had blood pressure, diabetes, allergies ,auto immune deficiencies ,illnesses, or vitamin deficiencies, imbalance, thyroid , heart issues , Irondeficiency ,menopause ,hormone issues , recen pregnancies, postpartum ,pregnancy
Any information that you add on this form is strictly for Sharlena Bell and Malaysia Bell’s eyes only.
How did you hear about us?*
Please Specify name a friend or family member*

Please give reference of any two people whom you feel can benefit from our healthy hair care services. You will receive a $25 discount at your service.

	Full Name	Contact Number
1
2

CONSENT TO PHOTOGRAPH/VIDEO RECORDING AND USE OF MEDIA** I, the undersigned, hereby grant permission to Pure and Healthy Hair Salon and its representatives to take photographs and/or video recordings of me and/or my hair, hairstyle, and related services provided at the salon. I understand and agree that these images and/or recordings may be used for the following purposes: 1. **Marketing and Advertising**: Including but not limited to social media platforms, websites, brochures, flyers, posters, and other promotional materials. 2. **Educational and Training Purposes**: For internal training, educational videos, and instructional content. 3. **Portfolio Development**: To showcase the skills and work of the salon staff in both digital and print formats.

YesNoBack of the head only