Client Request Form

1

What is your full name?

First Name

Last Name

2

EmailPlease note, I will be reaching out by email to confirm your appointment.

example@example.com

3

Phone Number

Please enter a valid phone number.

5

What services are you interested in booking?* This field is required.

7

How would you describe your hair density?* This field is required.

Very thin/actively thinning

Thin

Medium/average

Thick

8

When is the last time you had your hair colored?* This field is required.

I've never colored my hair

Less than 4 weeks ago

1-2 months ago

2-4 months ago

4-6 months ago

6+ months

9

Have you ever colored your hair at home?If so, please explain when you started and how many times.

10

What date & time would you prefer to come in?I will reach out to you to let you know if I have that date available & if not we can discuss other dates around that time.

11

File Please upload 1-2 pictures of what your current hair looks like

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

12

Please Upload 1-2 inspiration pictures

Drag and drop files here

Select files to upload

Max. file size: 10.6MB