Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Method of Contact *

Phone

Email

Text

What is your current hair length? *

Short

Medium

Long

Have you had any recent hair treatments or colour? *

Yes

No

Do you currently use any at-home hair treatments or colour? *

Yes

No

Do you have any known allergies or sensitivities related to hair products? *

Yes

No

How often do you heat-style your hair? *

Never

Rarely

Weekly

Daily