Form
GinaCurl Consultation Form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
What service are you requesting?
*
Please Select
Ginacurl
Ginacurl Retouch
If you are requesting a ginacurl retouch, has it been at least 6 months since your last ginacurl? ( at the time of your next appointment you must have waited 6 months)
Yes
No
Have you had any chemicals in the last 5 years? Color, smoothing treatments, and constant protein treatments are included. At home remedies that create protein? Henna?
Yes
No
If yes, what chemicals? Please include the date and exact type of chemical. Rinse’s and semipermanent color are included as a chemical. (Ex. Highlights with bleach May2023 )
Front of head/hair In natural state / pull one piece of hair so I can see length stretched
Browse Files
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of
Back of entire head/hair in natural state/ pull one piece of hair so I can see your hair stretched
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Choose a file
Cancel
of
Have you had any anesthesia in the last 6 months
Yes
No
Are you pregnant or 3 months or less postpartum?
Yes
No
Are you taking any GLP 1’s?
Yes
No
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