Hair Consultation Form

Client Details

Full Name: *

Date of Birth: *

Contact Number: *

Email: *

Medical Information

Are you currently taking any medications? *

Please list: *

Do you have any allergies or intolerances? *

Please list: *

Do you have any medical conditions? *

Please list: *

Have you recently been unwell? *

Which of the following were you unwell with? *

Please provide detail: *

Emergency Contact Details

Emergency Contact Name: *

Emergency Contact Phone: *

Emergency Contact Relationship: *

Services

Please select the hair service(s) you are interested in:

Cutting:

Adult Cut Kids Cut Bang Trim Beard Trim Cut and Shampoo Cut Shampoo and Style

All-over Color:

Permanent Semi Specialty Gray blending

Highlights:

Mini Partial Full Cap

Special Services:

Formal Styling / Special Occasion Blow Out Perm / Relaxer / Retexturizing

Deep Conditioning:

Basic Conditioning Specialty Conditioning

Hair Photos

Upload photos of your current hair:

Upload photos of how you would like your hair to look:

Please note these photos are for consultation purposes only and we cannot make any guarantees of your final hair look

Hair Condition

When did you last visit a hair salon? *

How long is your hair currently? *

What is the current condition of your scalp? *

What is the current condition of your hair? *

Hair loss Split ends Itchy scalp Dandruff Damage due to heat Breakage Dry/Brittle Normal Other

If Other, please specify:

Have you ever colored your hair (professionally or at home)? *

What type of color did you have/use, and was this done at a salon or at home? *

When was the last time you colored your hair? *

Have you ever experienced an allergic reaction to color/dye? *

Please specify: *

Have you had any hair loss problems? *

Please list the hair products you are currently using (include brands if known): *

ANY ADDITIONAL NOTES/COMMENTS:

Photography

Please tick the relevant boxes if you give us permission to take photographs of your treatment(s):

I give permission for my photograph(s) to be used within the salon for display / educational purposes I give permission for my photograph(s) to be used within other printed publications I give permission for my photograph(s) to be used on the salon’s social media pages / website

Signature: *

Tap or click on the signature above to sign