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VIVIFY HAIR STUDIO

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NEW CLIENT FORM

First Name

Last Name

Email

Phone

Grey Coverage

Yes

No

Color I'm Interested In:

Creative Color

Root Touch Up

Highlighting

Balay Touchup

Haircut & Gloss

Brazilan Blowout

Hair Treament

HAIR TYPE

Have you used Box Color in the past 3 years?

Current Hair Photo

Select File

Hair Goals

Select File

Hair History

Thank you filling out the form, please allow 48hrs for response

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