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First Name

Last Name


Phone Number

Have you ever seen a Studio417 stylist?
 Yes No

If Yes, who? (If you don't know, no problem!)

If Yes, when did you last visit the salon? (Approximate date is fine!)

What is your current hair length?

How would you describe your scalp?

How would you describe the current condition of your hair?

Shampoo frequency:

How would you describe the natural texture of your hair?*

 Straight Wavy Curly

How would you describe the density of your hair?*

 Fine Medium Thick Super Thick

Are you currently taking any medication that has side effects that can cause hair thinning and/or hair loss?*

 Yes No

Do you have now, or have had in the past, any problems with hair loss?*

 Yes No

Do you have professional color on your hair at this time?

 Yes No

Do you have unprofessional (at home) color on your hair at this time?

 Yes No

When was the last time you colored your hair?

Did your last color service take place in a salon?
 Yes No

Please describe your last three hair services (Ex. Haircut in April, highlight and cut in July, haircut in September)

What products are you currently using at home (shampoo, conditioner, treatments, styling products)

Please provide two current pictures of your hair.
Photo 1:
Photo 2:

Please send two to five images of a hair style you hope to achieve.
Photo 1:
Photo 2:
Photo 3:
Photo 4:
Photo 5:

Please give us more information about your hair, how you style it, what you like and dislike about your hair, and the look you want to achieve.

Select Services/Treatments:
 Blowout or hair styling Haircut Color service Curly hair specialist Texture or perm services Straightening or smoothing services Extensions or wig services Eyelash extensions Make up Brow shaping or tinting

Please select an approximate budget for your hair care needs:

Please select your availability for appointments: (select all that apply)
 Weekday Mornings Weekday Afternoons Weekday Evenings Weekends