Appointment Request Form

1

What services are you interested in?

Hair Extensions

Color

Haircut

Scalp + Hair Health Treatments

2

Thank you so much for your interest.

Ashley is currently only welcoming clients seeking her specialty: hair extensions

(other services can be booked WITH extensions, but no cut or color requests if you're not receiving extensions)

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

If you're seeking non-extension services, please reach out to our friends:

>> Johna @ Lux + Lunar - Hazleton - (272) 315-6564

accepting all color services, no haircut only requests please

>> HUE Hair Lounge - Mountain Top - (570) 474-5150

haircuts, root retouches, blonding and other services

>> The Hive Salon Collective - Pittston - (570) 671-4483

haircuts, root retouches, blonding and other services

>> Interlude - Hazleton - (570) 582-9388

waxing, facial and massage services

3

Nice to meet you! What do you like to be called?* This field is required.

First Name

Last Name

4

What are your preferred pronouns?* This field is required.i.e. she/her, he/him, they/them, etc.

5

What goals would you like to achieve with hair extensions?* This field is required.

I want to increase the density of my hair on the sides and/or back

I'd like my hair to be a 2"-3" longer than it is now

I'd like my hair to be as long as possible

I want to camouflage the hair loss on the top of my head with a customized removable topper

I'm looking to blend a haircut I'm growing out

6

Do you currently have extensions installed in your hair?* This field is required.

YESNO

7

What are you looking to achieve with your color?* This field is required.Select all that are applicable

Gray coverage

Blonding

Glosses/toners/glazes

Vivid colors (pink, green, etc)

Only need color if I need to adjust for my extensions

No color needed at this time

8

Please upload 1-3 inspiration photos of your hair goals

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

9

Please upload 1-3 photos of your hair currently* This field is required.We would like to see it from the back and the front, unfiltered. Natural light is best so we can see clearly.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

10

Please list any allergies to products, fragrances, oils, dyes or any other substances that we should be made aware of.* This field is required.

11

If you need any accommodations, please let us know. We offer after-hours appointments, lap desks + headphones to work remotely or do homework, quiet appointments, fidget toys, ear plugs, weighted blankets, coloring books and our entire space is ADA accessible. We are happy to support your needs!

12

Sweet! Who should we thank for sending you our way?If it was a person, they get a $25 thank-you credit and you also get a $25 credit at your first appointment!

Google

Social Media

Other

13

What's the best way for us to reach you?* This field is required.

TEXTCALL

14

Phone Number* This field is required.

Please enter a valid phone number.