Barber and Color Services

First Name

Last Name

Email

Phone

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Hair History and Current Condition

Have you colored your hair before?

Yes

No

If yes, when was your last color service?

If yes, what type of color was used?

Have you ever used box dye or henna on your hair?

Yes

No

If yes, what brand/color and how long ago?

Do you have any previous chemical treatments? (Check all that apply)

Perm

Relaxer

Keratin Treatment

Other

If other, please explain:

Do you have any hair/scalp sensitivities or allergies to color products?

Yes

No

If yes, please specify:

Are you taking any medications that could have an effect on your hair?

Yes

No

If yes, please specify:

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Submit a picture of what your hair currently looks like and an inspiration picture.

Submit Photo

Inspiration Photo