Name *

First Name

Last Name

MAINTENANCE GOALS: How often are you looking to sit in my chair? *

Once a Year/Special Occasion

LOW MAINTENANCE: 2-3x per year

LIVED IN: Every 8-12 weeks

CONSISTENT: Every 6-8 weeks

Select a hair service *

Maintenance Cut

Transformative Cut

Root Re-Touch

Highlights/ Lowlights

Balayage/ Hair painting

Toner/ Gloss/All Over Color

Gray Blending

Vivid Color / Fantasy Color

Hair Styling (Special Occasion)

Corrective Color

How often do you shampoo & conditioner in your hair? *

Everyday

2-3 times per week

Once per week

What is the current condition of your hair? *

Hair loss

Damage due to heat

Split ends

Breakage/ Overprocessed

Itchy scalp / Dandruff

Dry / Damaged

Won't hold color

Well Water/ Hard Water

None of the Above

In the past 6 months have you? *

Highlight or Balayage

Professional Color

Root Color

All Over Color

Vivid, Bright or Temporary Color

Keratin Treatment or Smoothening Treatment

Box Color / Home Color

None of the Above

Have you experienced any issues with hair loss in the past year? *

Yes

No

Accuracy of Information Provided *

I confirmed that all information indicated in this form is true and accurate.