Digital Consultation Form

Digital Consultation Form

We are so excited that you are taking the first step to your hair transformation. We can’t wait to meet you. All new guests start with this digital consultation form. This allows us to get to know you and your hair goals so that we can ensure that we can meet your expectations. Please complete the form in full and I’ll be in touch within 24 hours of your request during my work week which is Monday-Saturday. All requests submitted Saturday evening-Sunday will be responded to on Monday. If you have any questions or need support please email us at hrbyitzel@gmail.com
What is your full name?*

First NameLast Name
Birthday - just the month and day you can put this year for the year

MonthDayYear
Date
What is your mailing address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please note, I will respond by text to confirm your appointment
What is your email address? *
Please note, I will be reaching out by email to confirm your appointment
Emergency Contact*

NameNumber
How did you hear about us?*
What digital resources have you already checked out?

WebsiteInstagramFacebookGoogleYelp
Describe what you'd like to achieve during your visit:
What services you are currently considering?*

WigsToppersHair SystemToupeeHair extensionsOther
What products are you currently using for your hair at home?
What are some of your primary hair concerns:
Which of the following have you experienced in the last year:

ThinningAlopeciaMale Pattern BaldnessBreakageGreasy HairSplit EndsScalp Irritation/BurningFlakey ScalpLack of VolumeDamageHair Loss due to Medical Condition: Ex. Chemo, medication, etc.
Have you ever had an adverse reaction to color, latex, or glue:
Have you ever met with another hair replacement specialist?
Have you ever had a hair replacement service/hair system purchase you weren't happy with?
Why did you leave your last hairdresser?
How often do you prefer to come into the salon?
Have you or do you currently have a hair system or extensions installed in your hair?*

YesNo
What is your anticipated budget:

Less than $350Less than $500Less than $800Less than $1,000Less than $1,200Less than $2,000$2,500+
Is there anything else we should know before booking your appointment?
Should be Empty: