New Client Inquiry for Extensions

1

Name* This field is required.

First Name

Last Name

2

Email* This field is required.

example@example.com

3

Phone Number* This field is required.

Please enter a valid phone number.

4

First time visit?* This field is required.

YESNO

5

Are you an out of state client?* This field is required.

YESNO

6

AppointmentPick a 30 minute party window

7

How would you describe the current state of your hair?* This field is required.

Naturally curly

Relaxed or permed

Natural silk press

Colored or bleached of any kind

Wavy, no chemical

8

Upload a photo of your hair in it’s natural state* This field is required.

9

What service are you interested in getting?* This field is required.

10

Have you ever had seamless extensions?* This field is required.

YESNO

11

What is the length of your natural hair?* This field is required.

Short (earlobe, chin or above shoulder length)

Medium (on or at the shoulders)

Medium to long (below shoulders to bra length)

Long to extra long (lower back to hip length)

13

What is your natural curl pattern?* This field is required.

Straight 1A-1C

Wavy 2A-2C

Curly 3A-3C

Kinky curly 4A-4B

Coily-kinky straight 4C

14

What condition is your hair currently?* This field is required.

Healthy (no split ends, no damage)

Thinning/shedding

Heat damage

Hair loss

Breakage of any kind

Dry/itchy scalp

Brittle/hard/dry hair

Scalp build up/skin sensitivity

15

Please describe what you would like to see differently for your hair?* This field is required.

16

Upload a photo of inspiration or your desired look.* This field is required.

17

Signature* This field is required.

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