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

Services & Pricing *

New clients are required to receive the Signature Hair Painting Package service for their first appointment. New client pricing ranges from $450-475+ Please note: - If corrective color work is needed, I require a complementary in-person consultation prior to booking an appointment. - Filling out this form does not guarantee an appointment.

Yes, I understand and accept the services and new client pricing.

Policies *

Yes, I agree to the appointment and cancellation policies.