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01.
BOOK APPOINTMENT
Menu
02.
CONSULTATION
HAIR
CONSULTATION
03.
First Name
Last Name
Email
How often do you go to salon for hair treatment?
Every Week
Every 2 Weeks
Every 3-4 Weeks
Every 2 Months
Every 2-6 Months
Twice a Year
Once a Year
How long is your hair?
Short
Medium
Long
Kindly Describe the status of your scalp.
Dry
Normal
Oily
How often do you apply shampoo & conditioner to your hair?
Everyday
Every other day
Twice a week
Once a week
What is the current condition of your hair?
Hair Loss
Heat Damaged
Split Ends
Breakage
Itchy Scalp
Dry Hair
Dandruff
What is the current condition of your hair?
Permanent Hair Color
Keratin Treatment
Relaxer
Bleach
When did you last visit a hair salon?
Do you have any hair loss problems?
Have you ever been diagnosed with alopecia?
What are your hair goals?
Are you currently taking any medication that causes hair loss, thinning or excessive growth?
Do you enjoy styling your hair or does it feel like a chore?
Please indicate the list of hair products you’re currently using:
Any special instructions, comments, or suggestions?
Do you suffer from psoriasis or eczema on the scalp?
Yes
No
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