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* 1. What is your full name

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* 2. At what email address would you like to be contacted?

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* 3. What is your phone number?

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* 4. Have you ever had a perm or relaxer service

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* 5. Please describe your hair texture, length, & color.

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* 6. What chemicals have you used on you hair in the last 3 years. (Check all that apply even if they have faded or worn off or has been covered up. This is very important. Knowing about the nitty gritty details, helps me give you the best hair service possible)

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* 7. How did you hear about me as a stylist?

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