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Hair Consultation Form
1
Select a hair service
Adult Hair Cut
Kid Hair Cut
Cut & Shampoo
Hair color (Permanent)
Hair color (Semi)
Hair Color Blending
Hair Conditioning
Hair styling (Formal)
Hair styling (Special Occasion)
Perms
Relaxers
Retexturizing
Highlights
Other
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2
Select an appointment
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3
Client's Name
First Name
Last Name
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4
Client's Phone Number
1
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5
Client's Email Address
example@example.com
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6
Occupation
2
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7
Date of Birth
-
Date
Month
Day
Year
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8
What hair style do you like?
3
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9
Upload an image of hair you prefer
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
You can upload multiple files here
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10
Tell us something about your hair
4
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11
Upload an image of your current hair
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
Browse Files
You can upload multiple files here
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12
How often do you go to salon for hair treatment?
Every week
Every 2 weeks
Every 3-4 weeks
Every 2 months
Every 2-6 months
Twice a year
Once a year
Other
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13
How long is your hair?
Please Select
Short
Medium
Long
Please Select
Please Select
Short
Medium
Long
5
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14
Kindly describe the status of your scalp.
Please Select
Dry
Normal
Oily
Please Select
Please Select
Dry
Normal
Oily
6
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15
How often do you apply shampoo and conditioner in your hair?
Every day
Every other day
Twice a week
Once a week
Other
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16
What is the current condition of your hair?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Other
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17
Have you use the following in your hair before?
Permanent hair color
Keratin Treatment
Razor cut/Thinning
Relaxer
Henna
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18
When did you last visit a hair salon?
-
Date
Month
Day
Year
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19
When did you last apply professional or unprofessional color in your hair?
7
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20
Do you have any hair loss problems in the past?
8
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21
Are you currently taking any medications? If yes, please list them below. If not, leave it blank.
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22
Please indicate the list of hair products you're currently using:
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23
How did you hear about us?
Facebook
Twitter
Instagram
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Other
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24
Any special instructions, comments, or suggestions?
9
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25
Terms and Conditions
*
This field is required.
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26
Client Signature
Clear
10
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27
Date Signed
-
Date
Month
Day
Year
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28
Terms and Conditions
*
This field is required.
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