Name *

First Name

Last Name

Phone *

(###)

###

####

Date of Birth

MM

DD

YYYY

What type of color service(s) are you interested in scheduling? Check all that apply.

Gray coverage color.

Natural looking, low maintenance color.

I want to be blonde!!!

I want to go darker or red!

I am interested in a keratin smoothing treatment.

"Girl, I have no clue what I want, but I know i want a CHANGE!"

Haircut and style.

I need a color correction.

Other

Have you had a perm or any other texture treatments in the last 3 years?

Yes

No

What day(s) of the week do you prefer?

Monday

Tuesday

Thursday

Friday

Saturday

What time of the day is best for you?

Morning

Afternoon

Evening

My hair is...

Fine

Medium

Coarse

What color is your natural hair?

Blond

Light Brown

Medium Brown

Dark Brown

Gray (less than 50%)

Gray (more than 50%)

What is your ponytail circumference?

Less than 2 inches

2-3 inches

3-4 inches

Over 4 inches

Does your hair tangle easily?

Yes

No

When was the last time you colored your hair?

MM

DD

YYYY

How do you *most often* style your hair, if at all? *

Straightened

Curled

In a ponytail

I don't style my hair

Which of the following best describes you?

I only get my hair done 1-2x per year.

I want mild up-keep, touch ups every 7-12 weeks.

I am willing to /used to gettin my hair done every 8 weeks.

I want to see you every 4-6 weeks for touch-ups, treatments, me time.

Have you ever had an adverse reaction to hair color?

Yes

No

Have you ever used henna on your hair?

Yes

No