Dapper Hair Club Hair Appointment

1

What's Your Name?* This field is required.

First Name

Last Name

2

What's Your Email Address?* This field is required.

example@example.com

3

Whats the best number to contact you on?* This field is required.

Area Code

Phone Number

4

What kind of hair loss do you have?* This field is required.

Receding

At The Crown

Patchy Baldness

All Over

5

How prominent is your hair loss in that area?* This field is required.

A little (Only I notice it)

Some (Those close to me notice it)

A lot (Its obvious to everyone)

6

Which of the following best describes your hair type?* This field is required.

Straight

Curly

Afro/Kinky

Other

7

When would you prefer to have the service done?* This field is required.

ASAP

In the next 1-2 weeks

Within the next 30 days

In the near future, no rush

8

What's the best time to call you?* This field is required.

Hour

Minutes