Hair Extensions Intake Form

If you are a new guest looking to get hair extension services done, please fill out the form below. This form will help us to get to know you better as well as to understand your needs when it comes to hair extensions. Please feel free to contact The Eclectic with any questions you may have!

First name

Last name

Date

Month

Day

Year

Pronouns

Phone

Preferred method of contact

Have you ever had extensions before? If so, what type?

What was your previous experience with extensions, clip in hair extensions included?

What method of extensions are you interested in?

Are you currently experiencing hair loss/thinning/shedding in large amounts that is concerning?

Are you currently on any medications that can induce more hair loss/thinning?

Have you been diagnosed with any forms of alopecia?

Are you currently experiencing hair breakage from chemical hair damage (ie bleach damage, perm damage, etc)?

What is your lifestyle (ie mom, active, working womxn)?

What is your daily styling preference?

What is your main end goal to achieve by getting hair extensions?

The
Eclectic

Hair Extensions Intake Form

Location

Hours

Contact