Name *

First Name

Last Name

Phone *

(###)

###

####

Have you used any type of at home dye on your hair in the last 5 years? *

Box dye

Henna

Sun in

Another at home hair dye

No, I have not used

Do you have any permanent color on your hair? *

Ex. All over dark color or root coverage

No

Yes

Are you looking for grey root coverage? *

Yes

No

Have you had any chemical treatments done in the past year? *

EX: keratin treatment, brazillian etc.

Yes

No

What days work best for you? *

Tuesday

Wednesday

Friday

Please note: *

*New client pricing starts at $455+ * Filling out this form does not guarantee an appointment.

Yes, I acknowledge and understand these terms.

Policies & Pricing *

Yes, I understand and agree to the cancellation policies and service pricing.