Name *

First Name

Last Name

Phone *

(###)

###

####

Is it okay to text you at this number? *

Yes

No

Are you experiencing hair loss or thinning? *

Yes

No

Are you experiencing hair breakage? *

Yes

No

Have you ever had your hair colored? *

Yes

No

Have you ever used henna or at-home coloring kits? *

Yes

No

Are you allergic to certain foods, ingredients, hair products, hair color or chemicals of any kind that could cause issues? *

Yes

No

Have you been happy with your past salon services? *

Yes

No

What type of service would you like to book? *

Check all that apply.

Women's cut

Men's cut

Child's cut

Curly Transformation

Free color consultation

Custom color

Color-retouch

Required hair extension consultation

Hair extension application

Which days of the week are best for your schedule for your appointment? *

Check all that apply

Tuesday

Wednesday

Thursday

Friday

Saturday