HAIR EXTENSION DIGITAL INTAKE
name
*
first name
last name
email
*
example@example.com
phone number
*
please enter a valid phone number.
Format: (000) 000-0000.
which result are you looking to achive
*
Please Select
add color without damaging my natural hair
fill in damaged/sparse areas around my face
add thickness + body
add thickness + length
what is your natural hair texture?
*
Please Select
straight
wavy
curly
kinky curly
what is your preferred length?
*
Please Select
short (top of shoulders or shorter)
mid (past shoulders to bra strap)
long (bra strap to bottom of rib cage)
extra long (to the booty)
have you worn extensions before?
*
yes
no
which type of extensions have you worn?
*
tape-in
k-tip
i-tip
wefts
clip-ins/halos
what did you like/dislike about your experience with this method?
*
how much time do you like spending on your hair each day?
Please Select
under 10 minutes
10-20 minutes
20-30 minutes
30+ minutes
are you interested in any of the following?
*
color
keratin treatment
none
have you experienced any noticeable hair thinning or hair loss within the last 12 months
*
yes
no
is there anything you'd like me to know that may be contributing to these changes?
*
health, medication, hormones, stress, etc.
what primary concerns are you hoping to address?
*
please share 2-3 photos of your hair currently
Browse Files
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Choose a file
front, back + side of the head in natural light, if possible. no selfies please.
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of
please share 1-2 inspo photos
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Drag and drop files here
Choose a file
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of
how would you prefer to meet for your extension design consultation?
*
virtual (google meet)
in-person at mod by mo
submit my form + reserve my consultation
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