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    First Name

    Last Name


    Phone Number

    Have you ever seen a Studio417 stylist?


    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?*


    How would you describe the density of your hair?*

    FineMediumThickSuper Thick

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


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


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


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


    When was the last time you colored your hair?

    Did your last color service take place in a salon?


    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 stylingHaircutColor serviceCurly hair specialistTexture or perm servicesStraightening or smoothing servicesExtensions or wig servicesEyelash extensionsMake upBrow shaping or tinting

    Please select an approximate budget for your hair care needs:

    Please select your availability for appointments: (select all that apply)

    Weekday MorningsWeekday AfternoonsWeekday EveningsWeekends