Hair Plan Intake Form

1

Name* This field is required.What is your first and last name?

First Name

Last Name

2

Phone Number* This field is required.

Double check this has no typos so I can reach you when its time to chat

3

Email Address* This field is required.

4

On a scale of 1-10, how happy or unhappy are you with your hair?* This field is required.

5

What brought you here?* This field is required.Check all that apply

Thinning at the crown or top of head

Thinning at the mids or ends of hair

Visible scalp

See-through hair

Hair breakage concerns

Thin or thinning hair concerns

Scalp health concerns

My hair has changed and im not sure what to do with it

Other

6

What are you interested in learning more about?* This field is required.Check all that apply

Replica Scalp(coming January 2027)

Weft Extensions

K-Tip Extensions

Mesh & Meshless Integration Toppers

Scalp & Hair Health

Cut or Color

I'm not sure

7

What would you most like to change about your hair?* This field is required.

8

Side photo* This field is required.Upload a photo of the side of your hair.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

9

Have you noticed increased shedding or a change in your hair's density/thickness?Check all that apply

Increased shedding

Lower density

Smaller ponytail

Greater scalp visibility

Receding hairline

No

10

Which best describes where you are at?

I know how I want to solve my hair problem

I know what problem im trying to solve but I am unsure of the best solution

I want to better understand my options

I'm not sure where to start

Other

11

Do you have a specific budget in mind for your hair?* This field is required.For Hair Extensions and Mesh Integration Systems, most people’s initial investment is $1500-3000.

$100-500

$500-1500

$1500-3000

$3000+

Other