Consultations 150 California St, Suite 207Newton, MA 02458 (617) 356-5794miavenezia.hair@gmail.com Name * First Name Last Name Phone * (###) ### #### Email * Do you have any allergies? Are you on any medications that have contraindications to dye? * Yes No How often do you wash your hair? * Are you pregnant or breastfeeding? * Yes No Have you used box/drug store dye in the last six months? * Yes No When was the last time you had a color service? * MM DD YYYY Thank you!