NEW CLIENT EXTENSION FORM

1

Full Name* This field is required.

First Name

Last Name

2

Contact Number* This field is required.

Please enter a valid phone number.

3

Email Address* This field is required.

example@example.com

4

Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

5

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

Yes

No

6

If so, please describe what type of extensions.

Example: I-tips, Tapes, Wefts, Keratin bonds, etc, If you also know what brand, include that as well.

7

Are you looking at getting color done?* This field is required.

Yes

No

9

Upload a photo of your. (Front view & Back)* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

10

Upload hair Inspo photos* This field is required.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

11

What are you looking for in extensions?* This field is required.

Example: Length, more fullness, etc.

12

How did you hear about Bleached Behavior Salon?* This field is required.

Instagram, Referral, ect.