Name *

First Name

Last Name

Phone

(###)

###

####

How long is your hair? *

***We do not specialize in short hair/pixie styling or cutting.

Pixie

Above the chin

Shoulder length

Mid back or longer

When was your last color service? *

1-2 months

3-4 months

6 months or longer

I have virgin hair

Is your current color professional or box color (any color not performed by a professional salon)? *

Professional

Box

I have virgin hair

What is your hair texture? *

Straight

Wavy

Curly

Extremely Curly

What is your hair density? *

Fine

Medium

Thick

Please confirm the following: *

I have well water in my home

I use Henna

I am taking new medication

I smoke cigarettes

I have a relaxer or have had a relaxer in the past 3 years. (We do not perform services going lighter on relaxed hair)

N/A

Please confirm the following: *

***We no longer accept color corrections on black store bought (box) hair color or black professionally colored hair.

I want to go lighter

I want to go darker

I want to neutralize brassy tones

I want a color correction

I want to add depth/dimension

Do you prefer a silent appointment? *

Yes

No

PATCH TEST CONSENT: While allergies to services are unusual, it is always possible. I understand a negative patch test does not guarantee I will experience an allergic reaction. I will contact my provider immediately and seek medical treatment at my own expense. Client must wait 48 hours after test to proceed with appointment. *

I consent to a patch test

I decline a patch test and will not hold my provider or its affiliates responsible in any way for a reaction I might experience. I understand the risks of not having a patch test performed.