Hair Extension Consultation Form

Name*

First NameLast Name

Phone Number*

Area CodePhone Number

Email*

example@example.com

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Appointment Date

What is the length of your hair?*

What is the color of your hair?*

What type of hair do you have?*

What's your hair texture?*

What length are you looking to be?*

14"18"22"24"

Pre-procedure questions*

	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 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 workout? How many days a week?

Please upload an image of your current hair*

Please upload an image of the hair that you want or your inspiration*

Browse Files

I confirm that all information I entered in this form is accurate and true.
I understand that I need follow pre-procedure and post-procedure care.
I understand that for cancelation or rescheduling, I need to contact Nikky Atkinson directly to get voice confirmation.
I confirm acknowledgment that the retainer paid will be applicable towards services rendered and is non refundable.
I released the salon for any liabilities or hold harmless for any damages, injury, or accidents that can happen during or after the procedure.
I understand that removal must be performed by a hair salon technician or extensionist.

By signing below, you agreed that you have read and understood the terms and agreement above.

Signature*

Date Signed*

Date

Hair Condition