Book Your Appointment!Phone: (727) 300-6520Address: 30669 US Highway 19 N. Suite 106Palm Harbor, FL 34689 Name * First Name Last Name Email * Phone * (###) ### #### How did you hear about me? If by referral, who referred you? Preferred day(s) of the week for appointment? * Wednesday Thursday Friday Saturday How is the current condition of your hair? * Select all that apply Healthy Normal Dry Seeing some breakage Dandruff Hair Loss Heat Damage Chemical Damage Natural w/ no chemical processing Have you used any of the following in your hair? * Select all that apply Professional Hair Color (Done in a Salon At-Home Hair Color (NO Judgement) Natural or Organic Hair Color Overtone Henna Relaxer | Perm Keratin | Brazilian | Smoothing Treatment Splat | Demi-Permanent Hair Color Colored Shampoo or Conditioner Products from Sally's Nothing When was the last time you had a color service or chemical treatment? * If you don't recall, the approximate date is fine. MM DD YYYY Have you ever had a painful, itchy, or tender scalp due to a coloring service? * Yes No What service(s) are you looking to book? * Consultation Haircut Root Touch-up (Permanent Color) All-over Color Change (Darker) All-over Color Change (Lighter) Dimensional Blonding (Balayage/Highlights/Ombre) Vivid Color/Fantasy Corrective Color Strengthening Treatment What would you like to accomplish with your hair appointment? * Thank you so much! I will be reaching out to you in the near future to set up a consultation.For your appointment, Crimson & Clover is located at 30669 US Highway 19 N. Suite 106 in Palm Harbor, FL 34689. If you need to call for any reason, please do so at (727) 300-6520.