Hair Extensions

Name *

First Name

Last Name

Phone

(###)

###

####

Preferred Date

MM

DD

YYYY

Have you ever worn hair extensions before? *

Yes

No

Have you experienced excessive hair loss or damage to your natural hair? *

Yes

No

Are you interested in extensions to help you “grow out” your hair? *

Yes

No

Does your hair tangle easily? *

Yes

No

Have you been ill, had surgery or taken any medication(s) in the past year? *

Yes

No

Are you presently experiencing an unusual amount of hair loss? *

Reason: chemo, stress, pregnancy, alopecia, hormones, etc.

Yes

No

Do you understand that traction alopecia is a risk of any hair extension service? *

Yes

No