You can always press Enter⏎ to continue
Welcome
Hi there, please fill out and submit this form.
10
Questions
START
1
Your Name
*
This field is required.
First Name
Last Name
Previous
Next
Submit
Submit
Press
Enter
2
Todays Date
*
This field is required.
/
Month
Day
Year
Previous
Next
Submit
Submit
Press
Enter
3
Do you already have an appointment scheduled with Heather?
*
This field is required.
YES
NO
Previous
Next
Submit
Submit
Press
Enter
4
Your email
*
This field is required.
example@example.com
Previous
Next
Submit
Submit
Press
Enter
5
Your phone number
*
This field is required.
Area Code
Phone Number
Previous
Next
Submit
Submit
Press
Enter
6
What is the date of your appointment?
*
This field is required.
/
Month
Day
Year
Previous
Next
Submit
Submit
Press
Enter
7
What service(s) would you like include in the consultation?
*
This field is required.
Select all that apply
Blonding
Haircut
New growth retouch/grey coverage
Extensions
Dramatic change with haircut and/or color!
Other
Previous
Next
Submit
Submit
Press
Enter
8
What are you currently liking and disliking about your hair?
*
This field is required.
Don't hesitate to be descriptive
Previous
Next
Submit
Submit
Press
Enter
9
Upload the most recent photos of your hair
*
This field is required.
Please include a selfie, each side, and any areas of concern (These are for reference only and will be kept private)
Drag and drop files here
Select files to upload
Take Photo
Cancel
of
Previous
Next
Submit
Submit
Press
Enter
10
Upload inspiration photos
*
This field is required.
These are photos which show what you would like your hair to look like and can be past photos of your hair, photos found on the internet, etc
Drag and drop files here
Select files to upload
Take Photo
Cancel
of
Previous
Next
Submit
Submit
Press
Enter
11
What chemical service(s) have you received?
*
This field is required.
Select all that apply
Blonding (foiling, balayage, cap, global platinum, etc)
Texture (Brazilian Blowout, perm, permanent straightening, relaxer, etc)
Single process (regrowth retouch, grey coverage, toner, semi/demi permanent)
Fantasy/fashion color (tinted shampoo/conditioner, Vivids/Pulp Riot/Manic Panic, etc)
Other
Previous
Next
Submit
Submit
Press
Enter
12
Blonding Services
*
This field is required.
Please Select
My blonding was done professionally
I did my blonding
Please Select
Please Select
My blonding was done professionally
I did my blonding
Select one
Please Select
4 weeks or less
1-3 months
4-6 months
6-12 months
over 1 year
over 2 years
I don't remember
Please Select
Please Select
4 weeks or less
1-3 months
4-6 months
6-12 months
over 1 year
over 2 years
I don't remember
How long ago?
Previous
Next
Submit
Submit
Press
Enter
13
Texture Services
*
This field is required.
Please Select
My texture service was done professionally
I did my texture service
Please Select
Please Select
My texture service was done professionally
I did my texture service
Select one
Please Select
4 weeks or less
1-3 months
4-6 months
6-12 months
over 1 year
over 2 years
I don't remember
Please Select
Please Select
4 weeks or less
1-3 months
4-6 months
6-12 months
over 1 year
over 2 years
I don't remember
How long ago?
Previous
Next
Submit
Submit
Press
Enter
14
Single process
*
This field is required.
Please Select
My color was done professionally
I did my color
Please Select
Please Select
My color was done professionally
I did my color
Select one
Please Select
4 weeks or less
1-3 months
4-6 months
6-12 months
over 1 year
over 2 years
I don't remember
Please Select
Please Select
4 weeks or less
1-3 months
4-6 months
6-12 months
over 1 year
over 2 years
I don't remember
How long ago?
Previous
Next
Submit
Submit
Press
Enter
15
Fantasy/fashion color
*
This field is required.
Please Select
My fantasy color was done professionally
I did my fantasy color
Please Select
Please Select
My fantasy color was done professionally
I did my fantasy color
Select one
Please Select
4 weeks or less
1-3 months
4-6 months
6-12 months
over 1 year
over 2 years
I don't remember
Please Select
Please Select
4 weeks or less
1-3 months
4-6 months
6-12 months
over 1 year
over 2 years
I don't remember
How long ago?
Previous
Next
Submit
Submit
Press
Enter
16
Other chemical services
*
This field is required.
Please include the service name, if it was done professionally or at home, and how long ago it was done
Previous
Next
Submit
Submit
Press
Enter
17
Signature
*
This field is required.
By signing this consultation form, you are giving Heather Parker-Crabtree permission to contact you and agree the information provided is the truth to the best of your knowledge.
Powered by
Jotform Sign
Clear
Previous
Next
Submit
Submit
Press
Enter
Should be Empty:
Question Label
1
of
17
See All
Go Back
Submit
Submit