NAME:

    EMAIL:

    Service Requested:

    5-YEAR CHEMICAL HISTORY:

    Please provide a list of any chemicals used (e.g. relaxers, henna, keratin treatments, hair coloring and volume of developer used, highlights, texturizers, etc.) used on your hair in the last 5 years along with the date.

    TREATMENT:

    DATE:

    TREATMENT:

    DATE:

    TREATMENT:

    DATE:

    TREATMENT:

    DATE:

    ATTACH PHOTOS OF HAIR:

    Please provide a clear photo in front of a white wall

    Natural Hair Wet FRONT

    Natural Hair Wet SIDE

    Natural Hair Wet BACK

    Stretched FRONT

    Stretched BACK

    Alternate Consultation Method

    If your photo files are too large to send using the above form, please fill out an e-mail to Hairstalentct@gmail.com with all previous treatments, hair history, and all requested photos attached to be considered.

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