By Laura's Hair Pre Extension Consultation Form
Customer Information
Name
First Name
Last Name
Age
Date of Birth
-
Month
-
Day
Year
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Hair Condition
What is the length of your hair?
What is the color of your hair?
What is the current condition of your scalp?
Normal
Dry
Oily
Scars
Other
Pre-procedure questions
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?
Do you regularly swim?
Have you been pregnant for the last 6 months?
Do you usually go to gym for a workout?
Are you wearing an eyeglass?
Please upload an image of your current hair
Please upload an image of the hair that you want or your inspiration
Browse Files
Drag and drop files here
Choose a file
Cancel
of
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 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
-
Month
-
Day
Year
Date
Appointment
Tell me more about your dream hair
Hair extensions prices go from 1200-2500 Us dollar is that to fits you ?
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