New Client Request Form
Hello lovely lady so glad you chose MD Extensions for your hair care needs! Let's get to know each other a little bit first.
First Name
Last Name
Email
Phone Number
How did you hear about MD Extensions?
Instagram
Facebook
Google
Referral
Preferred Contact Method (Phone or Email)
10
Detailed Hair History from last 5 years, including all chemical services, color services and hair loss history.
How would you describe your scalp?
Dry
Normal
Oily
Experiencing Scalp Issues
How would you describe the current condition of your hair?
Healthy
Slightly Damaged
Damaged
How would you describe the natural texture of your hair?
Straight
Wavy
Curly
How would you describe the density of your hair?
Fine
Medium
Thick
Super Thick
Are you currently taking any medication that has side effects that can cause hair thinning and/or hair loss?
Yes
No
Do you have now, or have had in the past, any problems with hair loss?
Yes
No
Please provide two current pictures of your hair with no filter and in natural light. Photo One:
Select a File
Please provide two current pictures of your hair with no filter in natural light. Photo Two:
Select a File
Photos of desired hair inspiration.
Select a File
Photo of desired hair inspiration.
Select a File
Can you describe what you like about your inspiration photos?
Do you have a Brazilian Blowout or Keratin Smoothing Treatment
Do you swim in chlorine water?
Do you wear your hair up often?
Do you currently wear hair extensions?
If so what method of extensions?
What service are you interested in? *Consultation is required before booking this service.
Goddess Locs Extensions
Microlink Hair Extensions
Hand Tied Wefts
Ktip Extensions
Itip Extensions
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