Dharmmie's Place Appointment Booking Form

Dharmmie's Place

Hair/Wig Extension Appointment Request Form
Customer Information
Name

First NameLast Name
Social Media Handle
ex: @instagram; @twitter; facebook.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Appointment Date
Hair Condition
What is the length of your hair?
What is the color of your hair?
What is the current condition of your scalp?

Other

Pre-procedure questions

Rows	Yes	No	Remarks
Have you had hair extension before?
Do you have a medical condition wherein hair loss is present like alopecia?
Are you currently in treatment for hair loss?
Are you currently taking medication for hair loss?
Do you have any skin-related disease?
Do you have any allergies
Are you sensitive to metals?

Please upload an image of your current hair
Please upload an image of the hair that you want or your inspiration

Cancelof
Products
prevnext( X )
Braid Crotchet and Hair Extensions
Advise on hair colour description.

$15.00 CAD Quantity



Knotless Box Braids
Check out our options for pricing.

$180.00 CAD Hair Size



Classic Braids
Check out our options for pricing.

$160.00 CAD Hair Size



Crotchet Braids
Check out our options for pricing.

$100.00 CAD Hair Option



Conrows and Weaves (Unisex)
Check out our options for pricing.

$80.00 CAD Hair Option



Wig & Human Hair Weave Installation
Check out our options for pricing.

Free Hair Option



Total

$0.00 CAD
Entertainment

Let's do this hair thing right.

Rows	Music	Movie Lover	Sweet tooth	Wine Lover	Remarks
So much music, too little time. ex: pop, rock, blues, country, etc.
If people in horror movies listened to me they would still be alive. Netflix & play with my hair. ex: action, romance, drama, horror, comedy, sci fiction, thriller, war, etc.
Abs are great but have you tried candy? ex: Chocolate, sweets, snacks, cupcake, soda, etc.
Save water drink wine. ex: sweet, brut, sparkling, etc.
I have a new hairstyle. it's called ''I tried'. Don't care.

Acknowledgment
- I confirm that all information I entered in this form is accurate and true.
- I understand that I need follow pre-procedure and post-procedure care.
- I understand that my hair has to be pre-washed and dried before appointment.
- I understand that for cancelation or rescheduling, I need to call the salon or clinic directly and talk to the staff to get voice confirmation.
- I confirm that the clinic does not provide a refund for deposit payments.
- I released the salon for any liabilities or hold harmless for any damages, injury, or accidents that can happen during or after the procedure.
- I understand that removal must be performed by a hair salon technician or extensionist.
By signing below, you agreed that you have read and understood the terms and agreement above.
Signature
Date Signed

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Date
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