Heal Thy Hair Client Assessment Request
Thank you for your interest in working with Heal Thy Hair. This is a service assessment request, not a booking. Share a little about your hair and what you are hoping for, and I will personally review your request. Availability is limited and submitting this form does not guarantee acceptance.
Your Information
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
City and State
*
Preferred Contact Method
*
Please Select
Email
Text message
Phone call
Service Interest
Which service are you requesting?
*
New Microlocs Installation
Microlocs Repairs
Microlocs Extensions
What is your ideal timeline?
*
Please Select
As soon as availability opens
Within 1 to 3 months
Within 3 to 6 months
I am currently researching
Are you flexible with timing?
*
Yes
Somewhat
No
Hair History
This form is for service assessment only. It does not provide medical diagnosis or treatment. Please consult a licensed medical provider for any medical scalp or skin condition.
Tell me about your current hair or locs
*
Do you currently have locs?
*
Yes
No
How long have you had them?
Have you had a previous microlocs or loc installation?
Yes
No
Have you had any of the following?
Repairs
Extensions
Color
Relaxer
Keratin or other chemical service
None of these
Do you have any current scalp concerns or sensitivities?
*
Yes
No
Please describe your scalp concern
What would you like Heal Thy Hair to know before reviewing your request?
Photos
Please upload 2 to 3 clear, recent photos. Use natural or bright lighting, avoid heavy filters, make sure your hair and scalp are visible, and upload current photos. Images only, no video.
Photo 1: Front or top view showing hair and scalp
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Photo 2: Back or side view showing overall hair
*
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Photo 3: Close-up of your main area of concern, if applicable
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Before You Submit
Acknowledgement
*
I understand that submitting this request does not guarantee a booking and that availability is limited.
Yes, I would like to receive helpful microlocs education and resources from Heal Thy Hair by email. I can unsubscribe at any time.
Yes
Your information will be used to review your request and to communicate with you about your assessment.
Submit Request
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