First Name
*
Last Name
*
Phone
*
Email
*
Which service are you interested in?
*
Hair Extensions
Hair Loss Solutions
Hair Topper
Scalp Therapy
Hair Colour
Smoothing
Haircut
What is your primary goal? (Select all that apply)
Add length
Add volume
Add both length and volume
Cover thinning areas
Colour
Treat damaged Hair
Reshape/Cut
Your current hair length is
Above shoulders
Shoulder length
Mid-back
Below mid-back
Are you experiencing any hair loss or scalp issues?
Overall thinning
Crown/top of head
Receding hairline
Patchy hair loss
Dry, flakey or irritated scalp
I have no concerns
How long have you been experiencing hair loss?
Less than 6 months
6-12 months
1-2 years
2+ years
Not Applicable
Have you consulted with a medical professional about your hair loss?
Yes
No
Not Applicable
Which area needs coverage?
Crown only
Full top
Partial top
Not Applicable
Have you worn a hair topper before?
Yes
No
Do you have an ideal budget in mind?
Insert a current photo of yourself from the front
Insert a current photo of yourself from the side
Insert a current photo of yourself from the back
If you have an inspo photo please upload it here
Your natural hair is
Fine
Medium
Coarse
Your hair texture is
Straight
Wavy
Curly
Coily
Have you chemically treated your hair in the past 6 months? (Select all that apply)
Color
Highlights/Lowlights
Permanent wave
Chemical straightening
None
How did you find about us!
Google
Instagram
Facebook
Friend/Family
Other
Is there anything else you'd like us to know?
Submit Intake Form