Name (first and last)
Address
D.O.B.
Mobile
Email
example@example.com
Do you take any medications that could cause hair loss? Yes / No
If yes, please list medications
Do you or have you ever had Alopecia? Yes / No
If yes, when was your last episode?
Do you have irregular hair loss? Yes / No
If yes, please explain
Do you have any allergies, including an allergy to copper? Yes / No
If yes, list allergies
Are you on a special diet? (i.e. Keto, Vegan, Vegetarian) Yes / No
If yes, please specify
How often do you shampoo your hair?
Does you hair tend to be oily? Yes / No
If yes, please explain
What hair care and styling products do you use?
Why do you want hair extensions?
Are you looking for length, thickness or both?
What length extension hair are you looking for?
What is your long term goal for your hair?
Have you ever had extensions before? Yes / No
If yes, what type?
What was your experience with those extensions?
Do you have any straightening treatment? If yes, what type? (i.e. Keratherapy, Brazilian blow out)
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