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CONSULTATION FORM
Contact Information
Full Name
*
Contact Number
*
Email Address
*
Street Address
*
Apartment, suite, etc
City
ZIP / Postal Code
Hair History
Have you had any of the following in the last 12 months?
Relaxer
Bleach
Colour
Keratin
Braids
Weave
Silk Press
Have you ever had a negative reaction to a hair product or treatment?
*
Yes
No
N/A
Have you had a relaxer, perm, or texture release?
*
Yes
No
N/A
Do you have heat damage or breakage?
*
Yes
No
N/A
Hair & Scalp Health
Do you know your hair type? (curl pattern, density, porosity – optional)
Yes
No
N/A
Do you have any scalp conditions? (e.g., dandruff, eczema, itchiness, tenderness)
Yes
No
N/A
Are you currently experiencing shedding or thinning?
Yes
No
N/A
Do you wash your hair weekly?
Yes
No
N/A
Lifestyle & Hair Goals
Do you currently use salon-grade haircare products?
Yes
No
N/A
Do you have a specific hair goal in mind? (e.g., length, colour, texture)
Are you happy to trim or cut your hair if needed for health?
Yes
No
N/A
Do you prefer low-maintenance styles?
Yes
No
N/A
Health & Sensitivities (Private & Optional)
Are you on any medication or managing a health condition that affects your hair? (e.g., PCOS, anaemia, endometriosis, stress)
Yes
No
N/A
Are you pregnant or postpartum?
Yes
No
N/A
Do you have any allergies or ingredient sensitivities?
Yes
No
N/A
Consent & Agreements
Do you consent to before & after photos/videos being used for social media?
Yes
No
N/A
Are you happy to be filmed during your service?
Yes
No
N/A
Do you understand that results vary depending on hair history and condition?
Yes
No
N/A
Do you agree to the salon’s booking, cancellation, and late arrival policy?
Yes
No
N/A
Upload Photos
What service are you interested in?
Please upload current up to date photos of your hair (Max size 10MB)
*
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