Intake Form -

New Color Form

Name *

First

Last

Mobile Number *

Email *

Have you had an allergic reaction to haircolor in the past? *

If yes, please explain what was the reaction?

What type of color do you use on a regular basis? *

Permanent color (This could either be to touch up grey roots or refresh/tone existing color)
Demi Permanent color
Temporary / fashion color

When was the last time you colored your hair? *

Where do you normally have your hair colored? *

How would you describe the color you currently have? *

If other, please describe

Have you ever had a Keratin smoothing service, a chemical relaxer or a perm? *

If yes, how long back?