Name *

First Name

Last Name

Phone *

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Preferred Method of Contact: *

Contact Hours: Mon - Fri 10AM - 6PM

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Email

What are your Hair Goals? (mark all that apply) *

New Color

Protective Styling

Transitioning (Back to Natural)

Length Retention

Volume

Grey Coverage

Defined Curls

Smoothing / Straight Hair

Product Recommendations

Something New (Stylist's Choice)

How would you describe your HAIR TYPE? (mark all that apply)

Currently Transitioning

Relaxed / Texturized / Permed

Straight

Wavy / 2a-2c

Loose Curls / 3a-3c

Kinky Curls / 4a-4c

How would you describe your current HAIR condition? (mark all that apply) *

Normal

Dry

Split Ends

Chemical Damage

Heat Damage

Knots

Hairline Breakage

Dull / Lacks Shine

Colored / Existing Previous Color

How would you describe your current SCALP condition? (mark all that apply) *

Normal

Dry

Oily

Itchy

Alopecia

Eczema

Hair Color History Part 1 - Last 2 years (mark all that apply) *

No Color / Virgin Hair

Professional Color

Box / DIY Color

Henna

Temporary/Rinse

Hair Color History Part 2 - Last 2 years (mark all that apply)

Weekly

Bi-weekly

Monthly

Every other month

Every 6 months

Yearly