Promotion Package Questionnaire
Please complete the form below so we can tailor your service.
Are you? (Male / Female / Other)
What city will you be traveling from?
What type of hair problems do you have / how long have you suffered from this?
What type of medical issues do you have / how long have you had this problem?
Are you taking any medications? If so, what medication(s)?
Are you allergic to anything? If so, what?
If you would like a custom unit, what style?
Have you previously worn a unit? (Yes / No)
Tell us about your lifestyle (so we can tailor the unit to fit your daily life)
Will you need a driver? (Yes / No)
Will you need a hotel? (Yes / No)
Favorite Beverage
Favorite Fruit
Favorite Food
Favorite Professional Team
First Name
Last Name
Email Address
example@example.com
Phone Number
Instagram Handle
Date you want service?
/
Month
/
Day
Year
Date
What is your budget? (e.g. Less than $500, $500 to $1,000, Over $1,000)
Submit
Should be Empty: