Form
GinaCurl Consultation Form
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
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.
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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Cancel
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 30 days?
Yes
No
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