Name *

First Name

Last Name

Phone *

(###)

###

####

How long is your hair currently? *

Medium length (above collar bone)

Long length (above bra strap)

Extra long (past bra strap/waist)

How thick is your hair? *

Fine/Thin

Medium/Average

Thick/Coarse

Do you require grey coverage? *

Yes

No

Have you used box dye or permanent hair color in the past 5 years? *

Box dye

Permanent color

No

Do you currently have hair extensions? *

Yes

No