Questionnaire
What’s your hair history?
Client’s Name
First Name
Last Name
Client's Phone Number
-
Area Code
Phone Number
Client's Email Address
example@example.com
Occupation
Date of Birth
-
Month
-
Day
Year
Date
What’s your hair inspiration?
A famous person or simply “good condition”
If you’d like to, please upload an image of hair you like
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You can upload multiple files here
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Tell me something about your hair
Is it long, fine, thick, damaged, curly? Etc
To help me prepare for your appointment, and also record your hair journey, please upload an image of your current hair.
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You can upload multiple files here
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Do you ever treat your hair with a “mask” or similar, if so how often?
Every week
Every 2 weeks
Every 3-4 weeks
Every 2 months
Every 2-6 months
Twice a year
Once a year
Other
How long is your hair?
Please Select
Short
Medium
Long
Medium is on or around your shoulders
How often do you shampoo and condition your hair?
Every day
Every other day
Twice a week
Once a week
Other
What is the current condition of your hair?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Damage due to colour
Other
Have any of these been used in your hair before?
Permanent hair color
Keratin Treatment
Relaxer/Straightener
Henna
Semi-permanent
Crazy/vivid colour
Other
When did you last visit a hair salon?
-
Month
-
Day
Year
Date
When did you last apply professional or unprofessional color in your hair?
Are you currently taking any medications? If yes, please list below. If not, please leave blank.
What hair products are you currently using?
Are you interested in using professional hair care products at home if you don’t already?
Yes
No
I’d like to know more before I buy
Other
How did you hear about me?
Facebook
Twitter
Instagram
Google Search
Referred by a friend
Other
Any special instructions, comments, or suggestions?
Client Signature
Date Signed
-
Month
-
Day
Year
Date
Submit
Should be Empty: