Loose Ends Salon Inc.,
Consultation Profile Questionnaire
Name: ______Email Address: ______
Mailing Address:______City______Fl______Zipcode______Phone: ______Alternate #: ______Age :______
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/keratin treatment? ____Yes ____No
When did you have your last chemical relaxer/keratin treatment?______
Do you flat iron your hair? ____Yes ____No
If so when was the last time? ______
Do you take any medications, vitamins, etc.? ______
Please describe your diet/ lifestyle? ______
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 of 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 indicate the hair length that most accurately describes the length of your hair. ______
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.
Do you wear hair color? ____ Yes ____ No. Is it permanent, semi or a rinse______
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 is your hair color now? ______
What color would you like to achieve? ______
Extensions or Hair Braiding
What type of hair extension or hair braiding have you worn? ______
Hair care Products
What brand of shampoo and conditioner do you at home? ______
Maintenance Products
What type of maintenance products do you use at home?
______