New Client Consultation Form

New Client Consultation Form
Customer Information
Full Name
First & Last Names
Age
Date of Birth

MonthDayYear
Date
Phone Number

Area CodePhone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Hair Condition
What is the colour of your hair?
eg. Black, Chocolate Brown, Blonde
What is the texture of your hair?
eg. Straight, Wavy, Curly
Do you know the colour code of your hair required?
eg. #1B Natural Black
What is the current condition of your scalp?

Other
How would you describe the length of your hair?

Other
How would you describe the thickness of your hair?

Other
Are you aiming for:
Which methods are you interested in?

Other
Pre-procedure Questionnaire:

Pre-procedure questions:

Rows	Yes	No	Remarks
Have you had hair extension before?
Have you had any issues with hair extensions in the past?
Do you have a medical condition wherein hair loss is present, such as 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 any metals?
Are you/have you been pregnant in the last 6 months?

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 contact the salon or instagram directly and talk to the staff to get confirmation.
- I confirm that I am aware deposit payments are 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

DayMonthYear
Date
Should be Empty: