Bring Your Hair Back to Life Consultation

Client Information

Client Name *

Phone *

Email *

Date *

Before Photos

Please upload clear, recent photos (jpg/png)

Upload Before Photos *

Photo angles included

Front (hair down) Back (hair down) Close-up of mid-lengths & ends Close-up of roots/scalp (if applicable)

I permit Dinah Lefranc to view these photos for consultation purposes *

Current Hair

Current Length

Short Collarbone Shoulder Mid-back Long

Texture

Fine Medium Coarse

Pattern

Straight Wavy Curly Coily

Condition (check all that apply)

Healthy Dry Damaged Porous Frizzy Split ends Chemically processed Extremely breakage

Hair History

Check all that apply & list dates/details

Heat styling regularly

Heat styling tools used

Chemical services previously (relaxer/perm/keratin/etc.)

Chemical services details

Extensions/wigs

Extensions/wigs details

Recent professional treatments (smoothing, bond-repair, Olaplex, etc.)

Treatment details

Daily Haircare & Routine

How often do you cleanse your hair?

Daily Every other day 2-3x/week Weekly Monthly

When did you last use a protein treatment?

2-3x/week Weekly Monthly 3-6 months Never

When did you last use a hydration treatment?

2-3x/week Weekly Monthly 3-6 months Never

When did you last use a moisturizing treatment?

2-3x/week Weekly Monthly 3-6 months Never

When was your last trim/cut?

<1 month 1-3 months 3-6 months 6+ months Never

Product use (check all that apply)

Clarifying shampoo Color-safe shampoo Sulfate-free Purple/toning Dry shampoo Mask/treatment Bond builder (Olaplex, etc.)

Other products

Styling routine (check one)

Silk press Twist out Rod set Wash & go Protective styles Ponytail/buns Braids

Other styling routine

Heat styling frequency

Daily Several times/week Occasionally Rarely

Swim exposure

Never Occasionally Weekly

Chlorine/salt water

Yes No

Sun exposure

Low Moderate High

Sleep protection

Cotton pillowcase Silk/satin pillowcase Scarf Bonnet None

Health / Allergies / Medical

Scalp/skin allergies or sensitivities

None Yes -- details below

Allergy/sensitivity details

Medications or medical conditions affecting hair/skin (incl. pregnancy/breastfeeding)

None Yes -- details below

Medical details

When was the last time you saw a dermatologist?

Never 2-6 months Last year 3+ years

Goals & Desired Outcome

Main goal (check all that apply)

Restore moisture Repair damage Reduce frizz Improve shine Strengthen/bond repair Trim & shape Scalp health Manageability

Other goals

How dramatic a change do you want?

Subtle Noticeable Transformative

Are you open to multiple sessions to restore hair health?

Yes No

Budget range for initial treatment(s)

$150-$250 $250-$500 $500+

Expectations & Preferences

Preferred homecare commitment

Low Moderate High

Will you purchase recommended homecare products?

Yes Maybe No

Any styling or haircut changes desired at this visit?

Yes -- details below No

Styling/haircut change details

What do you love about your hair?

What do you want to change or fix?

Photographs & Social Media

Optional

Permit before photos for salon use

Yes No

Permit after photos for salon use

Yes No

If yes, allowed use (check all)

Social media Website/portfolio Printed materials Educational

I want to review photos/videos before posting

I only want photos taken on my phone

Stylist Assessment

To be completed by Dinah Lefranc

Porosity

Low Normal High

Elasticity

Good Fair Poor

Recommended in-salon treatments & process

Estimated sessions/time

Estimated cost

Deposit

Aftercare & Follow-up Commitment

Client must return for recommended follow-up/maintenance visits (typically every 1-3 months) so Dinah can monitor hair health: Acknowledged

Client agrees to follow aftercare recommendations

Yes No

Recommended homecare products

Terms & Consent

I confirm the information provided is accurate to the best of my knowledge. I understand the risks related to hair treatments (including potential breakage) and agree to follow Dinah Lefranc's recommendations for restoring and maintaining hair health. I consent to recommended in-salon treatments and aftercare instructions discussed during my appointment. I understand that the hair may take 4-12 weeks to restore. Hair care takes time to repair.

Client Signature (type full name) *

Date *

Print Name *