Name *

First Name

Last Name

Phone *

(###)

###

####

What is your current color? *

Blonde

Red

Brunette

Do you have previously colored hair? *

Nope, virgin baby!

Yes, salon only.

Yes, box color.

Mix of salon and box

How often do you color your hair? *

Every 4-6 weeks

Every 6-8 weeks

Every 8-12 weeks

Over 12 weeks

Do you have well water? *

Yes

No

What is your hair density? *

Fine/thin

Medium

Thick

Extra thick

What is your budget?

$100-less

$150-300

Open budget, whatever it costs!