Extension Intake Form Name * First Name Last Name Phone * (###) ### #### Why do you want hair extensions? Please be specific: * Are you wanting a more temporary solution or something that will last as long as possible? * How long do you want your hair to be? * Shoulder Length Upper Back Mid Back Low Back At or Below the Butt What is the long term goal for your hair? * Have you worn hair extensions before? * Yes No If you have worn extensions before; when were they installed? How long did you wear them? Was it a good experience? Did you experience excess hair loss due to the extension service? Have you ever experienced excess hair loss or damage to your natural hair? * Yes No Describing your normal hair maintenance routine; what products do you use on your hair? * How often do you wash your hair? * Every day Every other day (3-4x per week) 1-2x per week Less than one per week Do you blow dry or style with heat appliances? * No Blow Dry Curling Iron Straightener Round Brush Air Wrap Hot Rollers If yes, how often? Every day 2-4 times per week Once a week Special ocassions How often do you cut your hair? * Every 4-6 weeks Every 6-8 weeks Every 8-12 weeks Every 4-6 months Once a year Less than once a year Do you color or perm your hair? * Yes No Are you currently taking any medications that can affect the skin and/or hair or under a physicians care for a hair or skin issue? * Yes No Have you been ill, undergone surgery, or given birth within the past 6 months? * Yes No Do you have any skin allergies or have a sensitive scalp? (i.e. prolonged use of a headband or sunglasses bothers you). * Yes No Do you sunbathe, use a tanning bed, or utilize sunless tanning sprays or lotions? * No Sunbathe Tanning Bed Tanning Spray or Lotion What are your special interests, hobbies, and exercise routines? * How often do you like to change your hairstyle or color? * Often Sometimes Fairly Frequently Almost Never Are you willing to take the time for your hair at the salon and at home? * Yes No Not sure yet Thank you! Your stylist will review your questionnaire shortly to prepare for your consultation. We look forward to seeing you!
