HAIR HISTORY & CONSULTATION FORM
Please read carefully before signing.
Client's Name
*
First Name
Last Name
Client's Phone Number
*
Format: (000) 000-0000.
Client's Email Address
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Select a hair service
*
Haircut & Style
Hair color (One Color)
Hair Conditioning/ Mask
Gray Blending
Hair styling (Event)
Balayage
Retexturizing
Highlights
Perms
Other
How often do you go to salon for hair maintenance?
*
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?
Please Select
Short
Medium
Long
Kindly describe the status of your scalp.
Please Select
Dry
Normal
Oily
How often do you apply shampoo and conditioner in your hair (Shower)?
*
Every day
Every other day
Twice a week
Once a week
Other
What’s your hair concern?
*
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Other
Have you use the following in your hair before?
*
Permanent hair color
Keratin Treatment
Razor cut/Thinning
Relaxer
Henna
Other
When did you last visit a hair salon?
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
When did you last apply professional or unprofessional color in your hair / Hair history for the past 2 years?
*
Are you currently taking any medications? If yes, please list them below. If not, leave it blank.
*
Please indicate the list of hair products you're currently using:
*
How did you hear about us?
Facebook
Tiktok
Instagram
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Other
Any special instructions, comments, or suggestions / what would you like and don't like on your hair ?
Upload an image of your current hair
*
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
Upload an image of your hair inspo
*
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
HAIR SERVICE CONSENT & POLICIES
Please read and acknowledge the following terms before receiving your hair service.
Age Requirement
*
Hair History
*
CLIENT ACKNOWLEDGMENT
By signing below, I confirm that:
Client Signature
*
Date Signed
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Print Form
Submit
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