Hair Colour Consultation Form

1
Name* This field is required.(full please)
First Name
Last Name
2
Date of Birth* This field is required.(For a fun gift every year!)
Date
Year
Month
Day
3
Phone Number* This field is required.
Please enter a valid phone number.
4
Email* This field is required.We do not share info. this signs you up for our loyalty program & monthly newsletter
example@example.com
5
How did you hear about us?* This field is required.If a friend referred you, please tell us who!
Google/Search Engine
Social Media
Other
6
When are you available for an appointment?* This field is required.
Days
Evenings
Weekends
Anytime
7
Do you have a preferred stylist?* This field is required.
Please Select
Please Select
Yes
No
If 'Yes", please tell us who!
8
What are your hair goals?* This field is required.
9
What are your haircare challenges?* This field is required.
No Volume
Too Thick
Dryness
Breakage
Frizziness
Won't Stay Curled
Dull
Curly & Don't Know What to Do
Other
10
What is your current haircare routine?* This field is required.
11
How long do you spend styling your hair?* This field is required.
Less than 15 minutes
30 minutes +
12
How comfortable are you styling your own hair?* This field is required.
Very Comfortable
Uncomfortable
I'd like some tips
13
What styling tools do you regularly use?* This field is required.
Flat Iron
Blow Dryer
Curling Iron
None
14
How often do you switch up your style?* This field is required.
Same every day
Change for special occasions
Change often
15
What hair products are you currently using?* This field is required.
16
Are you currently taking any prescriptions, vitamins, or hormones? If yes please list the items that may affect your service today.
Please Select
Please Select
No
Yes
If 'Yes', please list them above
17
Have you experienced scalp problems, hair loss or breakage?
Please Select
Please Select
No
Yes
If 'Yes', please tell us which one
18
When was the last time you used boxed colour at home?* This field is required.
Never
90 days or less
3 - 6 months
6 - 12 months
19
Please list the Colour Services you are inquiring about:* This field is required.
20
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the hair service being received.** This field is required.
I Agree
21
Signature* This field is required.
Powered by Jotform SignClear
22
To be able to properly treat your hair, we require a current selfie.* This field is required.Hair down, no hats please!
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
23
Please share some photos of your hair inspo & desired results* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
24
Tell us what it is that you like about your inspo pics:* This field is required.
Huge
Large
Normal
Small
Ok
Ok
Should be Empty: