STEP 1: CONSULTATION FORM w/ PHOTOS FOR NEW GUESTS

REQUIRED FOR NEW GUESTS AND RETURNING GUESTS WHO HAVE NOT BEEN SERVICED WITHIN A YEAR.

Photos must be attached in order to receive a follow-up call. Thank you!

First Name

Last Name

Email

Phone

I am here for services with:

[Check only one (1)]

• Tousled Hair Salon [Hair Services]
• Follice Fitness Scalp Wellness [Hair Restoration including Scalp Micropigmentation]
• Tossed Hat [Custom Hat Fittings & Repairs]
• Model for Permanent Make-UP [Nano, Ombre, Powder Brows, Lip Blushing, Eyeliner

When Is The Best Time of Day To Reach You?

Select All That Apply

Select Select Morning [10:00a.m. - 11:59a.m.] Afternoon [12:00p.m. - 4:00p.m.] Evening [5:00p.m.-7:00p.m.] All The Above

How did you us?

[Check only one (1)]

• Friend/ Family/ Co-worker / Neighbor
• Internet Search
• Social Media
• Walked-by/ Drove-by
• Hair Blog
• Online Magazine
• Other

Do you have a preferred stylist

(Check All That May Apply)

• Yes, I prefer the Junior Stylist (Zarayah)
• Yes, I prefer the Senior Stylist (Rita)

Which Service Are You Interested in Receiving?

(Check All That May Apply)

• Cut
• Color
• Hair & Scalp Conditioning Treatments
• Hair Loss and Thinning
• Keratin
• Style Only

When Was Your Last Hair Cut?

Check One

• 1-2 weeks ago
• 1-2 months ago
• 2-6 months ago
• 6 months to a year ago
• Its been a few years

Who Cut Your Hair Last?

Check One

• Me
• Family/Friend/Student (non-professional)
• Hair Stylist (professional)

Who Colored Your Hair During Your Last Service?

Check One

• Me
• Family/Friend/Student (non-professional)
• Hair Stylist/ Colorist (professional)

Which Type of Hair Color was Used During Your Last Color Service?

Check All That Apply

• Permanent
• Demi-Permanent
• Semi-Permanent
• Bleach
• Double-Lift Color
• Henna
• Rinse
• I'm unsure
• Vibrant/ Neon/ Pastel Paints
• Non-applicable

When Was Your Last Hair Color Service? *(See IMPORTANT NOTE below)

Check One

• 1-2 weeks ago
• 1-2 months ago
• 2-6 months ago
• 6 months to a year ago
• Its been a few years
• My hair is Virgin and has not been previously color-treated

Please Name which Hair Color Brand was used during your last color service

With My Hair Color Service I wish to go:

Check all that apply:

• Lighter with my overall hair color
• Darker with my overall hair color
• Match my natural hair color
• A few lighter face framing pieces
• Dimensional Hair Color
• Cover my gray hair completely
• Blend my gray hair (seeing fewer gray hairs, but a few will be noticeable)
• I'm unsure and need professional assistance on making this decision

Do You Currently have a fresh or grown-out hair smoother, straightener, relaxer, keratin, reformer or texturizer in your hair?

Check One:

• Yes
• No
• Something in my hair causes me to have uneven texture and I am not sure what it is.

When Was Your Last Hair Chemical Smoother/Straightener or Curl Reformer Service Performed?

Check One:

• 1-2 weeks ago
• 1-2 months ago
• 2-4 months ago
• 4-6 months ago
• 6 months to a year ago
• Its been a few years

Which hair smoother/straightener or curl reformer was Used During My Last Chemical Service?

Select One

Select Select Keratin Complex Brazilian Blowout Magic Sleek Texturizer Traditional Cream Relaxer Wave Nouveau GinaCurl Curl Reformer Curly Perm I'm unsure

Do You Currently Have Extensions/ Weave or a Wig Install in Your Hair? If so, how long have you had your hair in?

(Check All That May Apply)

• A few weeks
• A few months
• I just removed them
• I have not yet removed them

How Often Do You Deep Condition Your Hair At Home Or At a Salon?

Select One

Select Select Weekly Bi-Weekly Monthly Quarterly I Don't Really

Please best describe the strength of your hair.

Check One

• Strong with minimal daily shedding
• Somewhat strong could use some improvement
• Weak with alot of daily shedding
• I am unsure and need a professional to advise me

[HAIR/LOSS THINNING]  Are you currently under a Dermatologists care for your hair concerns?

Check One:

• Yes
• No

[HAiR LOSS/THINNING] How Often Do You Comb or Brush Your Hair In a Week's Time?

Select Select Daily Once A Week I Only Finger Thru It As Needed To Detangle Only On Wash-Day When I Condition I Don't Really

[HAIR LOSS/THINNING] Please list any topical treatments you are currently using to address your Hair Loss/Thinning:

Check One:

• Volumizing Hair Products (that may include shampoo, condition, serums, topical treatments)
• Thinning Hair Products (that may include shampoo, condition, serums, topical treatments)
• Minoxidil, Nioxin, Nutrafol,  Harklinikken
• I am not currently using any treatments

[HAIR /LOSS THINNING] I am currently:

[Please check one of the following]:

• Pregnant and taking Pre-Natal Vitamins
• I just had a baby and I am breast feeding and taking post natal vitamins
• Its been over 1-2 years since giving birth
• None of the Above

Upload  Photo (1) of Your Hair In Its Current State. [Front Profile Photo].

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Upload Photo (2) of  Your Hair In Its Current State. [Top of Head Photo}

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Upload Photo (3) of  Your Hair In Its Current State. [Side Profile Photo]

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Upload Photo (1) of Your Desired Cut and Style

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Upload Photo with your hair damp (not dried, blown-out or flat ironed)

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* IMPORTANT NOTE: Please note, if you are considering a  hair color service, we may also need to schedule an in-salon Hair Color Consultation in order to do a porosity and/or elasticity strand test prior to your hair color service to ensure the health of your hair. The photos you submit are never shared or posted. We delete all photos after your service is performed or if no service is performed.

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Thank you for taking the time to fill out our form

Thank you, we have received your Pre-Consultation Form. If we have any further questions, we will contact you at the time you specified.

We look forward to meeting or getting re-acquainted with your hair.

The Tousled Team!

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