Hair Extension Intake Form

1
What is your first Name?* This field is required.
2
Nice to meet you, {w}!

Welcome to Lox!
We're so excited to take a deeper dive into your hair goals and explore how we can bring your dream look to life.

Thank you for taking the time to fill out this form—your responses will help us better understand the current state of your hair, your goals, and ensure we’re fully prepared for your consultation.

Let’s get started!
3
What is your phone number?* This field is required.
Please enter a valid phone number.
4
What is your email?* This field is required.
example@example.com
5
Are you currently wearing any form of hair extensions?
YESNO
6
Which of the following describes your hair texture?* This field is required.
Fine
Medium
Coarse
7
Which of the following describes your hair?* This field is required.
Very little amount of hair
Medium amount of hair
A lot of hair
8
Do you colour your hair?* This field is required.
YESNO
9
Are you looking to change your hair colour completely or stay with what you have today?* This field is required.
Radically change my colour
Stay with what I have with minor adjustments
10
Show Us Your Current Hair
You're just one step away from completing your application. This final stage is essential in helping us understand your hair’s current condition so we can create a customized extension plan just for you.

Please follow the instructions below carefully and upload two current photos of your hair:

One from the front
One from the back

Photo Guidelines:
• Must be taken on your cell phone
• Have someone else take the photo — no selfies
• Use natural lighting indoors (no flash or direct sunlight)
• Hair must be down and visible from root to end
• Photos must reflect your current hair — no filters or edits

Thank you for your time and care in completing this application. We can’t wait to begin your transformation journey at Lox.
11
Upload your front shot* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
12
Upload your back shot* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
13
Hair inspiration pictures* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Browse Files
Cancelof
14
Are you currently on any medications that would impact your hair?
YESNO
15
Do you have any medical conditions which may affect hair loss?
Alopecia
Lupus
Diabetes
Cancer or receiving Chemotherapy/Radiation Treatment
Hormonal/Thyroid Problems
Scalp Infection
Anaemia
Menopause
Stress
Other
None
16
Do you pull your own hair out/suffer with the condition called Trichotillomania?
YESNO
17
Thank You for Completing Your Application
Your submission has been received, and we’re so excited to begin this journey with you.

Before your consultation, we want to be transparent about what to expect when investing in luxury hair extensions at Lox—both in time and financial commitment.

Financial Investment:
The initial cost of your hair extension experience can range from $450–$2,500+ depending on your desired length, volume, and method.

This includes:
• Custom-coloured, ethically sourced extension hair
• Your first installation
• A luxury in-salon experience tailored just for you
• At-home care guidance and support

Ongoing maintenance appointments are typically required every 6–8 weeks, with pricing starting at $150+ depending on the method and number of rows or wefts.

Time Commitment:
• Your first appointment can take 3–5 hours, depending on the transformation
• Maintenance visits are approximately 1.5–2 hours
• Daily care is essential to preserve your extensions and natural hair health
• High-quality products and regular trims are recommended to extend the life of your investment

At Lox, our goal is to ensure you feel confident, cared for, and absolutely in love with your hair—every step of the way.

We'll be in touch shortly to schedule your personalized consultation. If you have any questions before then, don’t hesitate to reach out.

We can’t wait to welcome you into the Lox experience.

— The Lox Team
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