Name *

First Name

Last Name

Phone *

(###)

###

####

Is there permanent colour on your hair? *

Yes

No

Are we maintaining what you already have or are we making a change? *

Maintenance

Making a change

Have you had any of the following done to your hair?

Brazilian Keratin Treatment

Stripped Colour

Henna or Vegetable Dye

Do you have extensions? *

Yes

No

Do we need to add any of the following to your service?

Haircut

Blowout

Style

I understand the purpose of providing this information, and I understand that Casi Gill Hair will only charge a fee if I do not attend my appointment without proper notice. *

I understand