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Do you currently have color on your hair? Yes No If yes, which brand and shade are you using? It is important for us to know which brand, so we can assess the ingredients.
What is your percentage of gray? %
What is your natural hair color?
What hair color was your hair as a child?
What color would you like your hair to be?
Do you mind some red tones in your hair or would you like to discourage red tones? Some red tones Discourage red tones
Have you had a reaction to the brand you are currently using? yes no If yes, please describe your symptoms:
How long have you been using your current hair color shade and brand?
For statistical purposes please answer the following questions:
What is your age?
How long have you been coloring your hair?
Have you always used the same brand and shade? Please explain in detail.
Do you smoke? yes no used to
Are you on any medications? yes no
If yes, what are the name of the medications?
Have you had surgery in the past three years? yes no
