Microloc Interest Form

Microloc Interest Form

We are happy to now accept clients for NEW INSTALLS ONLY . 🥰 Please fill out the information below to help make your new salon experience as smooth as possible.
Name*

First NameLast Name
Email*
example@example.com
Which installation service are intereyou in?*
Your Hair Profile

Hello, help me get to know you 🥰
How would you describe the current condition of your hair?*

DamagedSomewhat healthyHealthyNot sure
How would you describe the current condition of your scalp?*

ItchyFlakyDandruffPsoriasisTenderSomewhat healthyHealthyNot sure
Please describe any issues you’re currently experiencing. If none please write, healthy.*
How would you describe the natural texture of your hair?*

StraightCurlyKinky CurlyLoc’dOther
Do you have now, or have had in the past, any problems with hair loss?*

YesNo
Are you currently taking any medication with side effects that can cause hair thinning and/or hair loss?*

YesNoUnsure
When was the last time you colored your hair? *
Have you recently received any chemical treatments or heat styling to your hair? (Example: relaxer, color, blow outs, press, etc.)*

YesNo
If yes, which service have you received?
When was the last time you received a haircut?*
What is the current length of your hair? *
Time & Cost of service

Remember, Microloc services are time and cost intensive.
Are you willing and able to sit long periods of time with little breaks?*

YesNo
Are you willing and able to sit 5+ hours with little breaks?*

YesNo
Are you willing and able to remit a nonrefundable deposit?*

YesNo
Are you willing and able to pay $800+ USD for an install service?*

YesNo
Please upload a couple of loose natural hair selfies for us. No extensions please. For the best results please take a picture outside or with as much lighting as possible. You do not have to be a photographer but this will help us make sure you get the best salon experience possible.
Please take a couple pics!*
Please feel free to go into more detail about any questions you may have for your stylist.
I understand, have read and completed this questionnaire truthfully. I agree that this constitutes full disclosure, and that it supersedes any previous verbal or written disclosures. I understand that withholding information or providing misinformation may result in contraindications and/or irritation to the hair service being received.

Yes
Date

MonthDayYear
Date
Signature

Powered by Jotform SignClear
Should be Empty:

Microloc Interest Form

Your Hair Profile

Time & Cost of service

Please upload a couple of loose natural hair selfies for us. No extensions please. For the best results please take a picture outside or with as much lighting as possible. You do not have to be a photographer but this will help us make sure you get the best salon experience possible.