Section 1 - Send an image of yourself (optional)

• To send us an image, you can attach it here. Please ensure the image is either a gif, jpg, or png file and under 500kB / 0.5 MB.

  NOTE: A preview will show on the right. If it appears to be cropped, don't worry this is only temporary.

Section 2 - About You

• First Name*
• Surname*
• Address Line 1*
• Address Line 2
• Address Line 3
• Postcode*
• Telephone: Home
• Telephone: Work
• Telephone: Mobile*
• Email Address*
• Gender* Male Female
• Age Group* Up to 16 16-25 26-35 36-45 45 and over
• Birthday* DD MM

Section 3 - Your Hair

• How is the condition of your hair?
• What do you like best about your hair?
• What do you like least about your hair?
• Would you like to change your hair?
• Have you had your hair coloured before?
  Yes No
• If yes, when?
• Have you had your skin allergy test?
  Yes No
• If yes, when?

Section 4 - Further details

• Face Shape
  Oval Round Square Rectangular Heart Shaped
• Other (Face Shape)
• Hair Type
  Straight Wavy Curly
• Hair Texture
  Fine Normal Coarse
• Hair Growth Patterns
  Cowslick Whirl Double Crown Widows Peak Irregular Nape
• Other (Hair Growth Pattern)
• Scalp Condition
  Normal Tight Sensitive Dry Flaking
• Other (Scalp Condition)
• Which shampoo are you currently using?
• Which conditioner are you currently using?
• How often do you shampoo your hair?
  Daily Every Other Day Weekly
• Other (Shampoo Time)
• How do you style your hair?
  Finger Dry Natural Dry Diffuser Dry Round Brush Denman / Vent
• Other (Style technique)
• Do you use styling products?
  Gel Mousse Lotion Cream
• Other (Styling Product)
• How do you finish styling your hair?
  Flat Irons Tongs Heated Rollers Hot Brush
• Other (Finish Technique)
• Which product do you use to finish?
  Spray Wax / Pommade Serum / Gloss
• Other (Finish Product)

Section 5 - Finish and send

• How did you hear about us?
  Friend Family member Work colleague Search Engine Press / News Facebook / Twitter Brochure / Leaflet Hairpod - iPhone app Word of mouth Other (please detail on the right)
• Other (Hear about)
• Tick here if you do not wish to be contacted by the Stuart Holmes Hair & Beauty Salon for future promotions and news.
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  Please add the digits together above.