Location & Number

Cherry Hill Mall
Cherry Hill, NJ
856.288.3900

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Hair Assessment

This enables us to properly access your hair so we can maintain integrity and determine whether desired results are achievable. Please be as truthful as possible. The information collected from this form is only used by the Essensuals London Cherry Hill staff. Personal medical questions are in no way required but do help us formulate the best color service for you.

Your Name (*)

Your Email (*)

Have you used an Essensuals London NJ colourist previously?

Approximately, when was the last time you coloured your hair (month/year)?

What did you use?
Box ColourProfessionalHenna/Vegetable DyeSemi Permanent Gloss/RiseDemi Permanent GlossHightlightsBleachFeriaJust for MenWell Water (at Home or Vacation)Other

If "Other" please explain:

Have you had any of the following texture services within the last year or recently enough that it would still be in your hair?
RelaxerPermKeratinBrazillian Straightening TreatmentJapanese Straightening TreatmentOtherNone of the Above

If "Other" please explain:

Are you on any types of these medications?
Thyroid MedicationHormonal MedicationRecreational Drug Use (can affect colour)Other

If "Other" please explain:

Have you recently had Chemotherapy?
NoYes

Do you have any vitamin deficiencies?
NoYes

Are you pregnant or breast feeding?
NoYes

Do you have any allergies?
SulfatesHair ColourGlutenOther

If "Other" please explain:

What shampoo are you using at home?

Anything else you would like to mention?