Name *

First Name

Last Name

Are you under 16? *

Yes

No

Are you pregnant, suspect you’re pregnant or breastfeeding? *

Yes

No

Have you previously had any reactions to hair colour? *

Yes

No

Are you taking any tropical steroids or other immunosuppressant medicines since your last colour? *

Yes

No

Have you coloured your hair with a home box dye since your last appointment? *

Yes

No

In the last 5 years have you ever had an allergic reaction to any of the following?

Skin tattoos

Temporary tattoos

Permanent make up

Henna

Is this the first time you have had your hair coloured? *

Yes

No

Has it been more than 6 months since you last had your colour? *

Yes

No

Have you had any type of allergic reaction since your last colour? *

Yes

No

Have you had any of the following since your last appointment, if answer yes we will need to do a new skin test. Please come to the salon as we wont be able to colour your hair.

Coronavirus

Suspected Coronavirus

Coronavirus vaccination