Basic Client Information

First Name

Last Name

Email *

Phone *

Date of birth

Outcomes

What are you most excited about when it comes to having hair extensions? What's the first thing you're going to do? How are you looking to feel?

What is your main reason for getting hair extensions?

Select the main outcomes for getting hair extensions

Fullness

Length

Ideally, how often would you like to get your hair done?

Monthly

Every 1-2 Months

With Color Appointments

Other

Background & Lifestyle

Have you worn any kind of hair extensions before?

Yes

No

What type of hair extensions have you worn in the past?

Have you experienced any significant hair loss from wearing hair extensions in the past?

Do you frequently participate in activities where you sweat or get wet?

Yes

No

What activities and how often?

Where do you part your hair?

Do you switch your part or always keep it in the same place?

Switch it up

Always in the same place

Are you currently experiencing any abnormal shedding or hair loss?

Yes

No

What is the personal or professional opinion as to why this may be?

Approximately what is the longest your hair will grow by itself?

What hair care products do you currently use at home?

Have you had any chemical services performed to your hair in the last 6-12 months?

Yes

No

What chemical services have you had in the last 6-12 months?

Will you have any upcoming trips, vacations, experiences in the next 12 months?

Yes

No

Where are you planning on going or what do you plan on doing?

Health

Have you had any kind of surgery in the last 6-12 months?

Yes

No

Are you planning to have any kind of surgery in the next 6-12 months?

Yes

No

Do you use any deep conditioners or oils on your scalp?

Yes

No

Are you pregnant or planning to get pregnant?

Yes

No

Are you currently taking any supplements or medications?

Yes

No

What supplements or medications are you currently taking?

Additional Consultation Notes

Client Certification Signature *

Clear

By signing, I certify that the information on this form is accurate & true to the best of my knowledge.

Get In Touch

Email: [email protected]

Address:

526 Main St.

Bld 101 Suite 3

Huntington Beach

CA 92648

Hours:

Monday: Closed

Tuesday: 10am - 6pm

Wednesday: 10am - 6pm

Thursday: 10am - 6pm

Friday: Closed

Saturday: Closed

Sunday: 10-4

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19051 Goldenwest St, Huntington Beach, CA 92648, USA