MODEL SERVICES + CONTENT CREATION AT LARVA
Larva Hair & Skin Lounge, Brea
Name
*
First Name
Last Name
Phone Number
*
Format: (000) 000-0000.
Email
*
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Instagram
*
@example
Number of Followers
*
Other social accounts
*
Number of followers
*
Select any services interested in
*
Hair Color
Curly Cut
Layered Haircut
Highlights
Balayage
Trim
Hair Extensions
Wash & Blowout
Special Occasion Styling
Hair Treatments
Bangs
Dermaplaning
Hydrafacial
Acne facial
Anti-aging facial
Back facial
Upload an images of your current hair in natural lighting
*
Browse Files
Drag and drop files here
Choose a file
MUST UPLOAD PHOTO(S) OF YOUR CURRENT HAIR
Cancel
of
What are your hair goals?
*
N/A If only interested in skin services
What are your skin goals?
*
N/A if only interested in hair services
How often do you go to salon?
*
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?
*
Short
Medium
Long
Very Long
How often do you wash your hair?
*
Every day
Every other day
Twice a week
Once a week
Kindly describe the status of your scalp.
*
Dry
Normal
Oily
Other
Describe your hair by checking the options below: (You can select more than one)
*
Healthy
Damaged
Straight
Wavy Curly
Fine
Thick
Other
Do you have any hair loss problems or scalp issues in the past?
*
When did you last apply professional or unprofessional color in your hair? Please be as detailed as possible.
*
Are you currently taking any medications? If yes, please list them below. If not, please put N/A.
*
Please indicate the list of hair &/or skin products you're currently using:
*
What are your skin concerns?
*
How did you hear about our salon?
*
Facebook
Instagram
Tiktok
Google Search
Referred by a friend
Other
After completing & submitting this form a Larva Stylist will be contacting you when a model is needed. Appointments only. Discounted pricing for Model services only.
*
I understand
Print Form
Submit
Should be Empty: