Hair Replacement Consultation Form

Hair Replacement Consultation Form

Welcome! Thank you for trusting me with your hair journey. I understand that hair loss can be deeply personal, and I appreciate you taking the time to complete this confidential consultation before your appointment.Your answers will help me better understand your concerns, lifestyle, and goals so I can prepare personalized recommendations before we meet. Estimated time: 8–10 minutes.
About You (Client Info)
Full Name

First NameLast Name
Preferred Name
Date of Birth

MonthDayYear
Date
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
City
Occupation
Tell Me About Your Hair / Hair Loss
What brings you in today?

Other
When did you first notice your hair loss?
Where is your hair loss occurring?

Other
Have you received a medical diagnosis?
Have you seen any of these professionals?

Other
Medical / Health / Products
Current Medications
Supplements
Have you experienced any of these recently?

Other
How often do you wash your hair?
Products you currently use
Have you ever worn...

Other
Lifestyle & Preferences
How active are you?
Do you wear hats frequently?
What would you love your hair to look like?
What concerns you most?
Priorities / Importance Ratings
Natural appearance

1

2

3

4

5

1 is Not important, 5 is Very important
Comfort

1

2

3

4

5

1 is Not important, 5 is Very important
Ease of maintenance

1

2

3

4

5

1 is Not important, 5 is Very important
Longevity

1

2

3

4

5

1 is Not important, 5 is Very important
Budget

1

2

3

4

5

1 is Not important, 5 is Very important
Styling flexibility

1

2

3

4

5

1 is Not important, 5 is Very important
Investment & Financing
What investment are you comfortable making?
Would you like financing information?
Upload Photo – Front

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Upload Photo – Left Side

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Upload Photo – Right Side

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Upload Photo – Back

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Upload Photo – Top / Crown

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Referral / Extra Info
How did you hear about me?
Is there anything else you’d like me to know before we meet?
Agreement – Acknowledgment
Client Signature
Signature Date

MonthDayYear
Date
For Stylist Use Only
Appointment Date

MonthDayYear
Date
Consultation Notes
Preliminary Recommendations
Next Steps
Photo Uploads
Should be Empty:

Hair Replacement Consultation Form

About You (Client Info)

Tell Me About Your Hair / Hair Loss

Medical / Health / Products

Lifestyle & Preferences

Priorities / Importance Ratings

Investment & Financing

Referral / Extra Info

For Stylist Use Only

Photo Uploads