Haircolor Consultation Request Form -Mysite

Haircolor Consultation Request Form

This form is required for all new hair color guests. Please complete the form prior to your consultation to be considered for a new color service. A video consultation may still be necessary upon review of each submission and a salon team member will reach out to you with more details on booking a new color service.

First Name

Last Name

Phone Number

Are you natural or relaxed?

Natural

Relaxed

Transitioning

If relaxed, when was the last relaxer applied?

How often do you visit the salon?

At least 1-2 times a month

Every other month (every 6-8 weeks)

2-3 times a year

Occasions only

What is your hair color history? (list ANY color services including a rinse, within the last 3 years)

When was you last color applied?

Are you taking any medications currently?

yes

Have you ever had an allergic reaction to haircolor?

yes

If you have had an allergic reaction, please explain further.

When was your last trim or haircut?

How often do you use a flat iron?

What TYPE of flat iron do you use?

What color service are you requesting?

If you are traveling from out of town, which city?

Please upload a clear photo of your hair currently (side profile).

Please upload a clear photo of the BACK of your hair.

Please upload a photo of desired haircolor.

Chic Haus Salon + Extensions Haircolor Release Form:

waiver for chemical services

I aknowledge that I have shared any allergies with Chic Haus Salon + Extensions as well as any chemical history to the best of my knowledge. I understand that there may be a patch test done if the salon feels it is necessary due to certain allergies being shared. I will not hold the salon or stylist liable if in case of any or all allergic reactions; Reactions are not just limited to the scalp, burning, bruising, swelling, itching, blistering. I also understand that any recent surgeries or medications can affect color predictability. Hair may also change in texture due to any color applications as well as lightening.

Your Signature