Hair Extensions Consultation & Maintenance Form
Please complete this form to help us provide the best hair extension service and care recommendations.
Full Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Birthdate
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Why do you want hair extensions? Please be specific.
*
Do you want a more temporary solution, or something that will last as long as possible?
*
How long would you like your hair to be? What is your long-term goal for your hair?
*
Have you worn hair extensions before?
*
Yes
No
Which type were they? When were they installed?
*
How long did you wear them? Was it a good experience?
*
Have you ever experienced excess hair loss or damage to your natural hair due to a hair extension installation service?
*
Yes
No
If yes, please elaborate.
How often do you wash your hair?
*
What products do you use on your hair?
*
Do you blow dry your hair or style it with heat appliances (i.e. flat iron, curling iron, hot rollers)?
*
Yes
No
If yes, please elaborate.
How often do you cut your hair?
*
Do you color, perm, or straighten your hair?
*
Yes
No
If yes, how often?
What chemical procedures have been performed on your hair in the past 3 years?
*
Back
Next
Health
Are you currently taking any medication(s), or are you under a physician’s care?
*
Yes
No
If yes, please list all medications and/or explain your situation.
Have you been ill, undergone surgery, or given birth in the last six months?
*
Yes
No
If yes, please explain.
Do you have any allergies?
*
Yes
No
If yes, please explain.
Do you have a sensitive scalp (does the prolonged use of a headband or sunglasses bother you)?
*
Yes
No
If yes, please explain.
Are you currently experiencing an unusual amount of hair loss?
*
Yes
No
If yes, do you know why?
Do you sunbathe, use a tanning bed, or apply sunless tanning sprays or lotions?
*
Yes
No
What are your special interests, hobbies, and exercise routines?
*
How often do you like to change your hairstyle or color?
*
Back
Next
Hair Extension Service Consent Initials
Please initial below
Photo Release
*
I give permission for my hair to be photographed and used for marketing/social media
I do NOT give permission
I understand that my stylist will professionally color match the extensions as closely as possible, but slight variations may occur due to lighting, natural hair tones, and extension hair materials.
*
I understand that my natural hair condition plays a role in the success of hair extensions and that weak, damaged, or fragile hair may increase the risk of breakage.
*
I understand that some tightness or mild discomfort may occur for the first 24–48 hours after installation while my scalp adjusts to the extensions.
*
I understand that improper care, excessive tension, or failure to follow maintenance instructions may lead to matting, tangling, shedding, or damage to my natural hair.
*
I understand that hair extensions require regular maintenance appointments (such as move-ups or tightening) and proper home care to maintain their appearance and protect my natural hair.
*
I understand that I must brush my extensions properly, avoid pulling or excessive tension, and follow recommended care instructions to prevent tangling or matting.
*
I understand that I should properly secure my hair when sleeping and avoid activities that may cause excessive tangling or stress on the extensions.
*
I understand that extensions must be professionally removed or adjusted and that attempting to remove them myself may cause damage to my natural hair.
*
I understand that some shedding is normal with hair extensions and that the longevity of the hair depends on proper care and maintenance.
*
I voluntarily consent to receiving hair extension services and understand the risks and responsibilities associated with wearing hair extensions.
*
I understand that failure to properly brush, separate, and maintain my extensions may cause matting near the scalp, which may require professional detangling or removal.
*
Client Signature
*
Client Signature Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Back
Next
Aftercare
Please, screenshot to save image to ensure you follow correct aftercare
Maintenance Information
Submit
Submit
Should be Empty: