Hair Extension Consultation Form
Customer Information
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Hair Condition
What is the color of your hair?
What is the current condition of your scalp?
Normal
Dry
Oily
Scars
Other
Which of the following describes your hair?
Fine
Medium
Course
Which of the following describes your hair?
Very little amount
Medium amount
A lot of hair
Which of the following describes the length your hair?
Short (above shoulders)
Medium (collar bone)
Long (past shoulder blades)
Ex Long (mid back or longer)
Which extensions are you wanting?
Aqua Tape Ins
Halo Couture
Not sure
Pre-procedure questions
Rows
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 wearing extensions?
Are you currently taking medication for hair loss?
Do you have any allergies
Do you regularly swim?
Do you usually go to gym for a workout?
Have you had complications with extensions in the past?
Please upload an image of your current hair
Please upload an image of the hair that you want or your inspiration
Browse Files
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Signature
Date Signed
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Month
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Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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