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Personal
Information
Hair Color
Consultation Form
First Name
Last Name
Email
Phone
Upload a picture of the Front of your Hair
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Upload a picture of the Side Of Your Hair
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Upload a picture of the Back Of Your Hair
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Medical Considerations
Are you currently pregnant or breastfeeding?
Yes
No
Are you taking any medications that may affect hair growth or color results?(Examples: hormonal medications, thyroid medications, acne treatments, chemotherapy, and weight loss)
Do you have any known allergies or sensitivities to hair color products?
Are you Experiencing any of these scalp symptoms?
Dry
Oily
Itchy
Hair Loss
None
Do you have or have you had any of the following conditions? If Yes, please check the box:
*
Required
Dandruff
Eczema on your scalp
Scalp Infections
Rosacea
Scalp Disorders
Sensitve Scalp
Stress
Weight Loss Shots/Pills
Hair History
Have you ever had your hair colored?
Yes
No
How would you describe your hair density?
Fine
Medium
Thick
How would you describe your hair porosity?
Low
Medium
High
Unsure
Did you go to a professional for your hair services?
Yes
No
I Did It My Self
Tell me about your hair Journey over the last year. How often do you get your hair serviced?
What is your natural hair color?
What services have you had in the past 3-5 years? (check all that apply)
*
Required
Relaxer
Blow Out / Keratin / smoothing treatment
Demi / gloss
Permanent color
Highlights / balayage
Lightening / blonding
Henna
Box Color
Metallic dyes
Are you using hot tools on your hair?
Yes
No
How often do you use hot tools on your hair?
Every Day
Couple Of Time A Week
Couple Times Months
Only Blow Drying
Never
What kind of hot tool do you use the most?
Blow Dryer
Blow Out Round Brush
Straightener
Curlying Iron
Desired Color Goals
Are you looking for:
Subtle enhancement
Dimensional color
Major change
What services are interested in? (check all that apply)
*
Required
All over color
Root touch up
Demi / gloss
Permanent color
Highlights / balayage
Lightening / blonding
Are you open to a multi-appointment plan to reach your goal safely if needed?
Yes
No
Upload a picture of your Inspiration Photo
Upload File
Upload supported file (Max 15MB)
Upload a picture of your Inspiration Photo
Upload File
Upload supported file (Max 15MB)
Maintenance & Lifestyle
What type of shampoo do you currently use?
Professional
Drugstore
Unsure
How often do you wash your hair?
Daily
2–3x per week
Once a week or less
Are you willing to use color-safe, curl-friendly products recommended by your stylist?
Yes
No
Do you swim frequently or have regular exposure to:
Hard Water ( well water at home )
Salt Water ( ocean )
Chlorine ( pool )
Lake / River
Do you spend a lot of time in the sun, outdoors, or tanning beds?
Yes
No
How often are you willing to come in for color maintenance?
4-6 weeks
8-12 weeks
6 months
1 a year
Do you have a budget range in mind for today’s service?
under $100
$150 - $200
$250 - $300
$350 - $400
$450 - $500
What is most important to you today?
Hair health
Longevity
Low maintenance
Brightness / boldness
Grey Coverage
Grey Blending
Are you interested in hair extensions?
Yes
No
Are you interested in any of these other services?
Curl Cut
Straight Cut
Scalp Treatment
Detox Treatment
I understand that results may vary based on my hair history and condition.
I understand that achieving my desired result may require multiple sessions.
I understand that proper at-home care affects longevity and results.
Your Signature
Clear
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