Gina Curl: Chemical History Form To ensure GinaCurl is suitable for your hair, please complete the 5-Year Chemical History Form. Name * First Name Last Name Phone * (###) ### #### Email * 5-Year Chemical History: * Please provide a list of any chemicals used (e.g., relaxers, henna, keratin treatments, hair coloring and volume of developer used, highlights, texturizers, etc.) used on your hair in the last 5 years along with the date. Date MM DD YYYY Chemical History Date MM DD YYYY Chemical History Date MM DD YYYY Chemical History Date MM DD YYYY Chemical History Date MM DD YYYY Message Do you have any additional questions or concerns? Thank you!
