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Consultation
Consultation
kinkykollective_7kivtv
2019-08-22T14:56:40+00:00
Booking Your Consultation
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Your Information
Name
*
First
Last
Address
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Street Address
Address Line 2
City
State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
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Hawaii
Idaho
Illinois
Indiana
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Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
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Montana
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New Hampshire
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New York
North Carolina
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Ohio
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Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
ZIP Code
Email
*
Phone
*
Format: (###-###-####)
Alternate Phone
Age
*
- - - select age - - -
7-14 years
15-20yrs.
21-30yrs.
31-40yrs.
41-50yrs.
51-60yrs.
60+yrs.
Your Consultation
Goals
*
Please provide us information on what you are wishing to accomplish.
How are you currently wearing your hair?
*
Do you use a chemical relaxer?
*
Yes
No
When did you have your last chemical relaxer?
*
(Please check one)
- - - select - - -
Less than a month
1-2 months
2-4 months
More than 6 months
Do you flat iron your hair?
*
Yes
No
If so, when was the last time?
*
- - - select - - -
Less than a month
1-2 months
2-4 months
More than 6 months
Do you take any medications, vitamins, etc.?
*
Yes
No
If Yes, please describe.
Please describe your diet.
*
How often do you have a trim? When was your last trim?
Do you generally get. . .
*
Professional care
Do-it-yourself
Texture of hair:
*
Using a scale from 1-10, with 1 being very straight texture and 10 being tightest curl (very kinky), please give us an idea of your hair texture.
- - - select texture - - -
1
2
3
4
5
6
7
8
9
10
Density: Would you consider your hair to be. . .
*
- - - select density - - -
Very healthy
Fairly healthy
Damaged in great need of repair
Thinning
Bald in areas
Alopecia
Recovering from medications or radiation
Is your hairline
- - - select hairline - - -
Healthy
Thinning
Bald
Hair Length
*
Please check the hair length that most accurately describes the length of your hair.
- - - select - - -
1-2
3-5
6-9
10+
Are you interested in having your hair colored or a color correction?
Yes
No
Hair Coloring
Has your hair been colored already?
Yes
No
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 color is your hair now?
What color would you like to achieve?
Additional Information
What are you expecting from your visit?
- - - select - - -
Treatment recommendations
Style recommendations
Both
Other
If Other, please explain.
Is there any addiotional information you'd like us to know?
Preferred Date & Time: Please note we will do our very best to
Preferred Date (This date is for scheduling purposes only - Your final day and time will be confirmed once your questionnaire has been reviewed.)
*
Consultations are held: Wednesdays, Thursdays and Fridays 12:00 pm – 6:00 pm
Date Format: MM slash DD slash YYYY
What Time Would You Like To Schedule Your Appointment?
*
Alternate Preferred Date ( Please provide an additional date incase your first selection is not available.)
*
Date Format: MM slash DD slash YYYY
Alternate Time: Please provide an alternate time incase your first selection is not available.)
*
What type of consultation are you interested in?
In Person Consultation – $55
Skype Consultation – $35
Phone Consultation – $25
Total
You will be directed to PayPal to complete your purchase. Credit cards and Debit cards accepted.
$0.00
Phone
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