Appointment Request Form

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.(just for texting)

Please enter a valid phone number.

5

Would you like to add a Haircut to your color service?

YESNO

6

Tell me a little about your dream hair.* This field is required.

8

Upload photos of your dream hair inspiration* This field is required.helpful tip - find inspo of someone who has a similar natural root color as you

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

9

Upload photos of your current hair(front, back and roots)* This field is required.does not have to be your best selfie, this is just to get an idea for timing and goals

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

10

Tell me about your hair history for the past few years.* This field is required.what services are you currently getting done? what are your current struggles with your hair?

11

What is your current hair routine? What products are you currently using?* This field is required.

12

How often are you hoping to schedule maintenance appointments?* This field is required.

4-6 weeks

6-8 weeks

8-10 weeks

12 weeks+

14

How did you hear about Citrine?* This field is required.

Website

Google Search

Instagram

Referral

15

Who referred you, so we can thank them!* This field is required.