Hair Color Consultation Form
Share your current hair history, desired shade, and any scalp concerns before your appointment.
Client Name
*
First Name
Last Name
Consultation Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Hair & Chemical History
Which of the following best describes your hair's current condition or chemical history?
*
Virgin/Natural (never colored or chemically treated)
Previously or currently color-treated
Relaxed
Transitioning from a relaxer
Texturized
Previously lightened/bleached
Other chemical treatment
If your hair is previously or currently color-treated, please specify the previous hair color and shade used.
What type of previous color was used?
Permanent
Demi-permanent
Semi-permanent
Box dye
Professional color
Henna/plant-based
Unsure
Other
When was your last color service? (Approximate date or timeframe)
Have you ever used black or very dark permanent or box dye on your hair? If yes, when was it last applied?
Have you ever used a relaxer or texturizer? If yes, when was your most recent application?
Current hair or scalp concerns (select all that apply):
Increased shedding
Thinning
Breakage
Bald/thinning areas
Scalp tenderness
Itching
Flaking
Scabs/sores
Burning/sensitivity
None
Are there any areas of your hair that are noticeably thinner, weaker, or more fragile? Please describe.
Desired Color Result
What color do you want to achieve? Please describe your desired hair color result.
*
How light, bright, or noticeable do you want your color result to be?
*
Very subtle
Moderate
Vibrant
As close as possible to my inspiration photo
Upload an inspiration photo (optional)
Upload a File
Drag and drop files here
Choose a file
Cancel
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Health, Medications & Skin Sensitivity
Are you currently taking any medications or receiving medical treatments that may affect your hair, skin, scalp, healing, or sensitivity?
Yes
No
Unsure
If yes, please list the medication(s) or treatment(s):
Are you currently taking or receiving any of the following?
Blood thinners/anticoagulants
Antibiotics
Prescription acne or skin medications
Steroids
Hormonal medications/treatments
Weight-loss medications
Chemotherapy or radiation therapy
Infusions or injectable treatments
Other prescription medications that may affect your hair, skin, or scalp
None of the above
Unsure
If selected, please provide the medication/treatment name and, if applicable, when you last received it:
Client Confirmation
Client Signature
*
Signature Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Consultation
Submit Consultation
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