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Consultation Request
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Name
*
First
Last
Address
Email
*
Phone
How did you hear about us?
Date of Consultation
Have you had extensions before?
Yes
No
If yes, which method was used?
Have you ever suffered from hair loss?
Yes
No
If yes, stylist to assess if extensions are suitable for this client
Have you ever been diagnosed with alopecia?
Yes
No
If yes, stylist to assess if extensions are suitable for this client
Are you currently taking any medication that causes hair loss, thinning or excessive growth?
Yes
No
If yes, stylist to assess if extensions are suitable for this client
Do you suffer from psoriasis or eczema on the scalp?
Yes
No
If yes, stylist to assess if extensions are suitable for this client
Would you consider yourself to have a sensitive scalp?
Yes
No
If yes, stylist to assess if extensions are suitable for this client
Do you have any known allergies?
Yes
No
If yes, stylist to assess if extensions are suitable for this client
How often do you wash your hair?
Multiple Choice
Do you dye your hair?
Do you frequently go to the gym?
Do you go swimming?
Do you have any holidays booked?
Disclaimer
If yes to any of the above, please read Aftercare Guide. By signing this form, you are agreeing that you have read and understand the Aftercare Guide. If not, the client should be given this information, so they have full understanding of how to maintain hair extensions and how to ensure the hair's quality. Please sign to confirm that the information above is accurate and that your hair extension professional does not possess any information that you believe they should be aware of. You acknowledge and accept that Hair by Kelly Lamb cannot guarantee the quality or longevity of the hair if you do not buy the recommended products.
Client(s) and/or Representative
*
Date
*
Stylist
Date
Addition Information
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