artkiteks

Name *

First Name

Last Name

Phone *

please enter the best phone number where you an be reached.

(###)

###

####

When was your last color service?

MM

DD

YYYY

Is there permanent haircolor on your hair?

yes

no

Do you have grey hair to cover?

yes

no

Do you want to maintain what you currently have or are you looking to make a change?

maintain

make a change

Have you ever had a Brazilian keratin treatment, stripped your color, or used henna or vegetable dye? *

Brazilian blowout

Keratin Treatment

Stripped color

Henna

Vegetable dye

If yes, when?

MM

DD

YYYY

Do you need to schedule any other services?

yes

no

Jeff does NOT color extensions, do you have hair extensions?

yes

no

How did you hear about Jeff?

referral from another client

google search

instagram

facebook

other