Color Inquiry Form

PLEASE COMPLETE THIS FORM IF YOU ARE REQUESTING COLOR & HAVEN'T FILLED THIS OUT PREVIOUSLY. THIS WILL ASSIST IN EXPEDITING YOUR APPOINTMENT. THANK YOU!

Full Name*

First NameLast Name

E-mail*

Phone Number*

Area CodePhone Number

Gender*

MaleFemaleN/AOther

Please upload 1-2 recent head/ hair/facial pics*

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Who is your Current Consultant, Stylist or Barber? (Type Self if none)*

Have you used the following within the last 5-7 years?*

ANY COLOR BOX DYEBLACK DYE/RINSEHENNAANY PRODUCT THAT REQUIRED YOU TO MIX

Have you EVER had ANY color products in your hair? (wax, color shampoo, color conditioner, bleach, semi-permanent, professional service colors etc)*

YesNoUnsure

Please share any addtl products/experiences from color over the past 5-7 years*

Last time Hair or Locs were colored by any products listed above*

Hair Type*

Loc Maturity Type*

Hair Length*

Short (Above Ears/Face)Medium (Between Chin & Shoulders)Long (Under Arms/Bra Strap)Extra Long (Below Waist)

Hair Condition*

NormalDryOilyBreakage

Scalp Condition*

Skin/Scalp Sensitivity*

I have sensitive facial skinMy scalp is overly sensitiveUnsureDOES NOT APPLY TO ME

Please list any scalp/skin conditions, hair issues or allergies, medical history you would like us to know*

List the products you regularly or currently use and how you groom & maintain your scalp/ locs/ hair. Include how often you color/re-color/ touch-up your hair. *

Are you any of the following:*

Do you frequently experience/participate in the following:*

Excessive SweatingSwimmingWorking OutPlaying Sports/Physically Active

Type of Hair Color Service Desired:*

Upload 1-2 inpsiration pictures of the hair color you are interested in.*

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List any addtl concerns or describe what you are looking for with your color.*

How did you hear about us?*

The Loc Network & Affiliates