CombLine Consultation Form

Pre-procedure questions

Rows	Yes	No	Comments
Have you had hair extension before?
Do you have a medical condition wherein hair loss is present like alopecia?
Are you currently in treatment for hair loss?
Are you currently taking medication for hair loss?
Do you have any skin-related diseases or traumas?
Do you have any allergies?
Do you regularly swim?
Have you been pregnant in the last 12 months?
Do you workout?

Which area of the head are you interested in having CombLine applied? Please choose all that apply.
Do you have a particular budget you are looking to stay within?
Are you able to visit the salon every 4-6 weeks for maintenance appointments?
Please upload 1-2 images of your current hair in a well light area. Please photograph the area you would like CombLine applied.
Please upload 1-2 images of your current hair in a well light area. Please photograph the area you would like CombLine applied.
Please upload an image of the hair that you want or your inspiration

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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 rescheduling, I need to call or email the salon directly as soon as possible.
- I confirm that the salon does not provide a refund for deposit payments.
- I understand that if I do not show up to my appointment without a call or email my deposit will be forfieted.
- I released the salon for any liabilities or hold harmless for any damages, injury, or accidents that can happen during or after the procedure.
By signing below, you agreed that you have read and understood the terms and agreement above.
Signature
Date Signed

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Customer Information