Hair Extension Consultation Form

Hair Extension Consultation Form
Customer Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Request Appointment Date ( Pending Approval )
Hair Condition
What is the length of your hair?
What is the color of your hair?
What is the current condition of your scalp?

NormalDryOilyScarsOther

Pre-procedure questions

	Yes	No	Remarks
Have you had hair extensions before?
Are you currently in treatment for hair loss?
Are you currently taking medication for hair loss?
Do you have any allergies?
Have you been pregnant in the last 6 months?
Do you usually go to gym for a workout?
What is your availability for appointments?

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

Cancelof
Acknowledgment
- 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 call the salon or clinic directly and talk to the staff to get voice confirmation.
- I confirm that the salon does not provide a refund for deposit payments.
- I released the salon for any liabilities or hold harmless for any damages, injury, or accidents that can happen during or after the appointment.
- 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

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