Hair Extension Consultation & Waiver Form

Hair Extension Consultation & Waiver Form

Consultation & waiver form must be completed prior to an in person consultation. During our consultation we will discuss pricing based on method used and hair that will need to be purchased.
Customer Information
Clients Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Have you had hair extensions done by a professional before? If so what kind?
Why hair extensions?

Longer HairThicker HairBoth
What is the current condition of your scalp?

NormalDryOilyScarsOther

Pre-procedure questions

	Yes	No	Remarks
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?

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Customer Information