Free Consultation Hair Extensions Consultation Form Hair Extensions CONSULTATION FORM ✓ Thank you! Your consultation has been received. ✗ Please try submitting again. Your Information First Name Last Name Address Email Phone Health & Scalp Do you suffer from eczema on your head?* Select... Yes No Do you suffer from alopecia? Select... Yes No Are you currently on any medication that may cause hair loss? Select... Yes No Do you suffer from psoriasis on your head? Select... Yes No Do you have a sensitive scalp? Select... Yes No Are you allergic to any hair related products? Select... Yes No If yes, please specify Are you allergic to metal? Select... Yes No Are you pregnant or have given birth in the last 6 months? Select... Yes No Do you regularly use a swimming pool? Select... Yes No Extensions History Have you had hair extensions fitted before? Select... Yes No Method & when last fitted Your Hair Current hair condition Permed Coloured Straightened None of the above Natural hair thickness Fine Medium Thick Coarse Afro Permissions Before & after photos for website & social media? Select... Yes No I agree to aftercare conditions Select... Yes No I consent to my personal data being collected and stored for consultation purposes Select... Yes Submit Consultation