Hair Inquiry Form

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Welcome

Hi there, please fill out and submit this form.

18Questions

1
Client's Name
First Name
Last Name
2
Select a hair service
Adult knotless box braids
Kid knotless box braids
Adults regular box braids
Man hair style
Man dreadlocks Retwist
Locs
Adult twists
Crorrows braids style
Kids crorrows style
Other
3
Appointment* This field is required.
4
Client's Phone Number
5
Name
First Name
Last Name
6
Phone Number
Please enter a valid phone number.
7
Upload an image of hair you prefer
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
You can upload multiple files here
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8
Tell us something about your hair
9
Upload an image of your current hair
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
You can upload multiple files here
Cancelof
10
How long is your hair?
Please Select
Please Select
Short
Medium
Long
11
Kindly describe the status of your scalp.
Please Select
Please Select
Dry
Normal
Oily
12
What is the current condition of your hair?
Hair loss
Damage due to heat
Split ends
Breakage
Itchy scalp
Hair is dry
Dandruff
Other
13
Do you have any hair loss problems in the past?
14
How did you hear about us?
Facebook
Twitter
Instagram
YouTube
Online Advertisement
Google Search
Referred by a friend
Newspaper/Magazine
Other
15
Any special instructions, comments, or suggestions?
16
Terms and Conditions* This field is required.
17
Client Signature
Clear
18
Date Signed
Date
Month
Day
Year
Should be Empty:

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