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Client Profile
Name
*
Phone Number
*
Hair History
*
Hair History
A
Permanent Color
B
Bleaching / Lightening
C
Chemical Texturizing (Perming / Relaxing / Smoothing Treatment / Keratin Treatment)
Hair Texture
*
Hair Density
*
Do you have any of the following concerns?
*
Do you have any of the following concerns?
Dryness
Breakage
Heat Damage
Chemical Damage
Loss of curl pattern / texture
Uneven Color
Excessive Shedding
Frizz
Pregnant or Breastfeeding
*
Pregnant or Breastfeeding
A
Yes
B
No
C
Unsure
Please describe any allergies / sensitivities you may have:
*
Do you have any notes that you'd like to leave for your service provider?
*
Submit