Extension Consultation Form
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Request an appointment with which extension specialist?
Jenni Hannon
Faith Grant
Julie Eades
No Preference
Is your hair highlighted?
yes
no
Is your hair relaxed
yes
no
Is your hair permed
yes
no
Are there any other chemical treatments on your hair not listed above?
yes
no
If yes, what?
Are you on any medications that may cause hair loss?
yes
no
If yes, what?
Have you had surgery in the last six months?
yes
no option 2
Are you allergic to any metals, silicone or latex?
yes
no
What products do you currently use at home?
What are your hobbies, exercise and getting ready routine?
Have you had extensions before?
yes
no
If yes what brand/method?
What did you like?
What did you not like?
Hair is at least to your shoulders?
yes
no
Shortest layer is past the cheekbones? (minimun)
yes
no
Send a picture of your current hair in good natural lighting
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Send a picture of your goal hair
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Submit
Should be Empty: