Hair Color Consultation Form
Full Name
First Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Type of Hair Color Service
Blonding Package
Permanent color
highlights, lowlight
Hair extensions
other
Desired color
Please upload a photo of your current hair
Browse Files
Cancel
of
Would you mind uploading an image of the hair color you want?
Browse Files
Cancel
of
Type of Hair
Straight
Curly
Wavy
Fine
Asian
other
Current length of Hair
Short
Medium
Shoulder Length
Medium
Other
Hair Condition
Normal
Dry
Oily
Dry
other
Scalp condition
Flaky
Dry
Itchy
Oily
Other
Where did you hear about this salon?
Facebook
Twitter
Instagram
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Other
How often do you go to salon?
Please Select
Every week
Every 2 weeks
Every 3-4 weeks
Every 2 months
Every 2-6 months
Twice a year
Once a year
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?
Yes
No
Have you used a semi-permanent color before?
Yes
No
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?
Yes
No
If yes When ____________________
Have you had relaxer, perms, henna, or any other hair services not listed? If so, when
Yes
No
If yes when _____________________
Do you have allergic reactions to any products?
Yes
No
Do you have any synthetic hair?
Yes
No
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)
Yes
No
Any special instructions?
Date Signed
-
Month
-
Day
Year
Date
Client's Signature
Email
example@example.com
Name
First Name
Last Name
Submit
Submit
Print Form
Should be Empty: