Hair Consultation Form
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
Select an appointment
Client's Name
First Name
Last Name
Client's Phone Number
Format: (000) 000-0000.
Client's Email Address
example@example.com
Occupation
Date of Birth
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What hair style do you like?
Upload an image of hair you prefer
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
Tell us something about your hair
Upload an image of your current hair
Browse Files
Drag and drop files here
Choose a file
You can upload multiple files here
Cancel
of
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
How long is your hair?
Please Select
Short
Medium
Long
Kindly describe the status of your scalp.
Please Select
Dry
Normal
Oily
How often do you apply shampoo and conditioner in 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
Other
Have you use the following in your hair before?
Permanent hair color
Keratin Treatment
Razor cut/Thinning
Relaxer
Henna
When did you last visit a hair salon?
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
When did you last apply professional or unprofessional color in your hair?
Do you have any hair loss problems in the past?
Are you currently taking any medications? If yes, please list them below. If not, leave it blank.
Please indicate the list of hair products you're currently using:
How did you hear about us?
Facebook
Twitter
Instagram
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Other
Any special instructions, comments, or suggestions?
Client Signature
Date Signed
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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Print Form
Submit
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