Hair Color Consultation Form

Hair Color Consultation Form
Full Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number
Address*

Street Addres

Street Address Line 2

CityState

Postal / Zip Code
Type of Hair Color Service*

Blonding PackagePermanent colorhighlights, lowlightHair extensionsother
Desired color*
Please upload a photo of your current hair*

Browse Files

Cancelof
Would you mind uploading an image of the hair color you want?*

Browse Files

Cancelof
Type of Hair

StraightCurlyWavyFineAsianother
Current length of Hair*

ShortMediumShoulder LengthMediumOther
Hair Condition

NormalDryOilyDryother
Scalp condition

FlakyDryItchyOilyOther
Where did you hear about this salon?*

FacebookTwitterInstagramYouTubeOnline AdvertisementGoogle SearchReferred by a friendNewspaper/MagazineOther
How often do you go to salon?
When is the last time you visited a salon and what service did you receive ?*
Date or any approximate weeks
Have you used a permanent color before?*

YesNo
Have you used a semi-permanent color before?

YesNo
How often do you change the color of your hair?
Every month/Every 2 months/Quarterly/Yearly
Have you used box dye in the last 2-4 years?*

YesNoIf yes When ____________________
Have you had relaxer, perms, henna, or any other hair services not listed? If so, when*

YesNoIf yes when _____________________
Do you have allergic reactions to any products?*

YesNo
Do you have any synthetic hair?*

YesNo
What shampoo and conditioner are you using?
Are you using any hair products? If yes, please list them below:
Are you pregnant or nursing? Women)*

YesNo
Any special instructions?
Date Signed*

MonthDayYear
Date
Email*
example@example.com
Name*

First NameLast Name
Should be Empty: