TĀJI Restoration Pre-Consult Inquiry Form
Functional Trichology & Holistic Hair and Scalp Health.
Full Name
*
First Name
Last Name
This short form helps us understand your hair and scalp concerns before your complimentary 15-minute consult. It takes under two minutes to complete.
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Preferred Location
*
NYC
Atlanta
Virtual (for clients outside our service areas)
Your Virtual Consultation Our virtual consultation is a comprehensive 60-minute session ($325), designed for clients outside our NYC and Atlanta service areas. During this session, we'll discuss your health history, lifestyle, and hair and scalp concerns in depth, and outline a personalized path forward. Following your virtual consult, our at-home alopecia genetic DNA testing kits can be ordered and drop shipped directly to you as part of your ongoing assessment and care, when requested. Inquire about the TrichoTest during your session.
Virtual Consultation
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I'm ready to schedule my virtual consultation
I'm just exploring for now
What is your main hair or scalp concern right now?
*
How long has this been going on?
*
Less than 3 months
3 to 6 months
6 months to 1 year
Over 1 year
Have you had any prior testing or treatment for this concern?
*
Yes
No
Not sure
If yes, please briefly describe
The Crown Assessment is our comprehensive 90-minute in-clinic evaluation, investment $800. It is the recommended starting point if you are new to functional trichology or have not had prior testing. The Crown Assessment is not required to book with us. Several services are also available on their own, without completing an assessment first, including Root Reveal, Purify Reset, The Revival Treatment, and Peptide Restore.
Which best describes you?
*
I'm ready to book The Crown Assessment ($800)
I'm ready to book another service
I have questions and would like to talk with someone before booking
I'm just exploring for now
hello@tajirestoration.com • 347.896.TAJI (8254) • tajirestoration.com
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