Name *

First Name

Last Name

Phone *

(###)

###

####

Preferred Contact from Daysha

Text

Email

Instagram DM's

Are you comfortable having photos/videos taken of you and used on my social media platforms? *

Yes

No

Thickness of Hair *

Fine / Thin

Medium / Average

Thick / Coarse

Do you require grey coverage *

Yes

No

Do you currently have hair extensions? *

Yes

No

Have you used box day or permanent hair color in the past 5 years? *

Box Dye

Permanent Color

No