Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Method of Contact: *

Text Message

E-Mail

Phone Call

Preferred Time of Day for Contact: *

Morning (10am-12pm)

Afternoon (12pm-4pm)

Evening (4pm-7pm)

Flexible (10am-7pm)

Have you seen Francisca before? *

Yes

No

Were you referred by someone to see Francisca?

Yes

No

Select the type of service you would like to have: *

Check all that applies

Haircut

Hair Colouring

Colour Correction

Hair Treatments

Keratin Treatment

Perm

Japanese Straightening

Please select your availability *

Check all that applies

Weekday mornings (10am-1pm)

Weekday afternoons (1pm-5pm)

Weekday evenings (5pm-7pm)

Weekends (9am-4pm)

Flexible

How would you describe the current condition of your hair? *

Healthy

Slightly Damaged

Damaged

Shampoo Frequency *

Daily

3-4 times a week

2-3 times a week

Once a week

What is the current length of your hair? *

Short (3" to Above Shoulder)

Mid-Length (Shoulder to Underarm)

Long (Underarm or Longer)

Describe the natural texture of your hair *

Straight

Wavy

Curly

Describe the density of your hair *

Fine

Average

Thick