Hair extension

1

Name

First Name

Last Name

2

Email

example@example.com

3

Phone Number

Please enter a valid phone number.

4

Have you ever worn hair extensions before?

YESNO

5

If yes, when,? Please try and best describe what method was used and/or brand. IE: tape ins, hand tied, micro link (beads), keratin/fusion bond etc.

7

How often do you wash your hair?

Every day

Every other day

2-3 times a week

Other

8

Do you blow dry your hair?

YESNO

9

What products types and brands do you use on your hair? IE: shampoo, conditioner, styling products etc.

10

Are you currently taking any medications?

YESNO

11

If yes, please list what medications and how long you have been taking them?

12

Do you have a scheduled surgery in the next 6 months or had surgery in the past 6 months? Surgery can be linked to hair loss due to anesthesia.

13

Do you have any allergies (chemicals, medications, substances, materials, metals, or any others)?

14

Do you have any medical conditions that may interfere with this service? IE: migraines, headaches, sensitive scalp or history of scalp problems?

15

Are you currently experiencing an unusual amount of hair loss? Reasons: chemo therapy, new medication, stress, pregnancy, alopecia, covid, hormones, etc.

16

What workouts or activities do you do frequently?

17

Do you swim regularly? If so how often?

18

Any questions/concerns to talk about at your in person consultation?