Hair Extensions Intake Form

Hair Extensions Intake Form
Full Name*

First NameLast Name
Phone Number*
E-mail*
example@example.com
These questions are important for me to know prior to your in person consultation. This will give me a better idea of what extensions would best suit your wants and needs.
Have you been pregnant in the last 6 months?*

YesNo
Do you have any allergies to Metal?*

YesNo
Do you suffer from any form of hair loss?*

YesNo
Have you ever been diagnosed with alopecia?*

YesNo
Do you take any medications that would interfere with hair loss or extreme shedding?*

YesNo
Do you suffer from psoriasis or eczema to the scalp?*

YesNo
Do you have a sensitive scalp?*

YesNo
Please indicate if any of the following apply to your scalp condition*

NormalDryOilyDandruff
My hair is?*

CurlyStraightWavyFrizzy
My hair is?*

FIneMediumThickVery Thick
Do you frequently swim or go to the gym?*

YesNo
Do you currently color your hair?*

YesNo
If yes please inform of what you have done color wise
Have you ever had hair extensions done before?*

YesNo
If yes, please inform me of which ones you had.
What kind of Hair Extensions were you considering?
Should there be any other important information I need to be aware off please indication in the box below.
Please send pictures of your current hair to the following email:

ml.professional.hair@gmail.com

Thank you kindly for taking the time to fill out this form :) I am looking forward to working with you and your hair journey!
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