Name *

First Name

Last Name

Phone *

(###)

###

####

How long is your hair currently? *

Short - Chin length (above or just below)

Medium - Just past shoulders

Long - Mid chest

Extra Long - At or past waist

How thick is your hair? *

Thin/Fine

Medium/Average

Thick/Coarse

Do you require grey coverage? *

Yes

No

Do you currently have extensions? *

Yes

No

Have you ever had permanent color or box dye on your hair in the last 5 years? *

Yes

No