
Consultation Profile Questionnaire
Name:
Email Address:
Mailing Address:
Cell Phone #:
Alternate Phone #:
Age:
Goals: Tell us what you would like to achieve with your hair -
How are you currently wearing your hair?
Condition of your hair:
Do you use a chemical relaxer?	Yes No
When did you have your last chemical relaxer? (Please check at least one)
Do you flat iron your hair? (Please check at least one)	Yes No
If so, when was the last time?
Do you take any medications, vitamins, etc.? Please describe:
Please describe your diet:
How often do you have a trim? When was your last trim?
How often do you have hair treatments? When was your last treatment?
Do you generally get...	Professional care Do-it-yourself?
Texture of hair: Using a scale from 1-10, with 1 being very straight texture and 10 being tightest curl (very kinky), please give us an idea of your hair texture.
Density: Would you consider your hair to be -	Very thick Somewhat thick Medium thickness Thin Very fine
Hairline: Is your hairline -	Healthy Thinning Bald
Hair Length: Please check the hair length that most accurately describes the length of your hair.
What are you expecting from us?
Anything else you want us to know...
*Hair Coloring: If you are interested in having your hair colored or a color correction,* *please answer the following questions. If not skip this section and submit.*
Has your hair been colored already?	Yes No
If so, how often do you have your hair colored? When was your last color treatment?
Have you noticed any significant dryness of your hair since coloring?	Yes No
What color is your hair now?
What color would you like to achieve?