AI Scalp Consult Request
Complete this form to request your AI Scalp consultation. A $100 consult fee is collected today and applied toward your package.
Contact Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
How did you hear about us?
Please Select
Instagram
TikTok
Google
Friend/Family Referral
Existing Client Referral
Other
Hair & Scalp Details
Natural hair color
*
Which treatment areas are you concerned about?
Crown/top of head
Front hairline
Temples
Part line
Overall density
Other
Tell us about your hair concern in your own words. What are you experiencing? How long has it been going on? What have you tried?
*
Scalp Photos (Required Angles)
Please upload clear photos in good lighting. These help us assess your candidacy before your consult.
Crown view — phone directly overhead pointing down
*
Upload a File
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of
Front hairline — eye level straight on, hair pulled back
*
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of
Part line — camera above along natural part
*
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of
Left temple and side — head turned right, camera at eye level
*
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of
Right temple and side — head turned left, camera at eye level
*
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of
Additional photos (up to 3)
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of
Submit Consult Request
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