Hair Extension Consultation and Cost Form

Name *

Name

First Name

Last Name

Address *

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Email Address *

Home Phone

(###)

###

####

Cell Phone

(###)

###

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HAIR HISTORY

Current State of Hair *

Date of Last Relaxer

YYYY

Any Color? *

Have you ever been treated by a doctor for hair loss or scalp problems? *

Do you presently have any hairline breakage, thinning areas, or bald spots? *

Have you ever had any allergic response or adverse reactions to substances put onto your skin or scalp? *

HAIR WEAVE & EXTENSION HISTORY

When was your last install? *

Have you ever received or currently have the following hair weave or extension services? Check all that apply:

Sew In

Bond/Glue

Infusion

Interlock

Micro Rings

Micro Braids

Hair Unit/Replacement Wig

Closure

Other

Are you presently wearing weave or extensions?

If so what type? And is hair left out?

How long does your weave/extension style last?

HAIR MAINTENANCE

How often do you shampoo & condition your hair? *

What name brand products are you presently using in your hair? *

Do you have any scalp issues (ie: Dry, itchy, dandruff)? *

If so explain:

How often do you oil your scalp? *

How often do you use curling irons, flat irons, blow-dryer or any other hair heated appliances? *

How often do you visit the salon? *

LIFESTYLE

Do you exercise consistently? If so how often? And do you perspire heavily?

How well does your hair hold up?

Consultation Form