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Name

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Choose your service . If you are interested in one service or the other please only answer the questions the pertain to you
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
Have you ever had extensions ?
If yes, when and what type?
During any of these services, did you experience excess hair loss or damage to your natural hair? If yes elaborate.
How long is your hair now?
What is your long term goal for your hair?
How long do you want your hair ?
What products do you use at home and how frequently?
Do you and how often do you get the following services?
How often do you like to change your style or hair color?
Have you been ill, had surgery or on any medication in the past 6 months or year?
Do you have any allergies?
Do you have any medical conditions that may Interfere with this service.
Are you presently experiencing an unusual amount of hair loss?
Preferred days and times for consultation and/or appointment
Any questions or concerns regarding the service?
Please upload Pictures of your current hair

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Please upload pictures of your dream hair

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Do you have a medical diagnosis from a medical provider?
Are you aware of the financial investment of Mesh Integration?
Do you have medical insurance ? Would you like to see if you qualify for coverage under your insurance?
Please Attach Pictures of your current hair loss

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Consultation Fee
Please note that the consultation fee is non refundable. By making a payment, you are agreeing to these terms. The consultation fee does not apply toward services. It is a standalone consultation fee. Your consultation will take place via Zoom.

$150.00

Total

$0.00
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