Name *

First Name

Last Name

What is your primary hair goal? *

Color change

Healthy hair maintenance

Extensions

How often can you visit for maintenance?

4-6 weeks

6-8 weeks

3+ months

Have you used box or henna dye in the last 2-4 years? *

Yes

No

Have you used chemical treatments before (keratin, perm, straightening)? *

Yes

No

Do you have allergies or scalp sensitivities? *

Yes

No

Do you use heated tools regularly? *

Yes

No

What is your hair density? *

Thick

Medium

Thin

What is your current hair length? *

Short (Above shoulder)

Medium (Collar bone to armpit)

Long (Below armpit)

What is your natural hair type? *

Straight

Wavy

Coily

Curly