Hair Extension Consent Form
Please complete this form to provide your details and consent before receiving hair extension services.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Emergency Contact Name and Phone Number
*
Have you ever had hair extensions before?
*
Yes
No
What type of hair extensions are you receiving today?
*
Please Select
Tape-In
Micro-Link
Fusion/Bonded
Sew-In/Weave
Clip-In
Other
Do you have any allergies or sensitivities to adhesives, latex, or hair products?
*
No known allergies/sensitivities
Yes (please specify)
Are you currently taking any medications or have any medical conditions that may affect your hair or scalp?
*
No
Yes (please specify)
Please indicate your natural hair type:
*
Straight
Wavy
Curly
Coily
Desired hair extension length (inches/cm)
Desired hair extension color
Signature (Please sign below to confirm your consent)
*
Submit Consent
Submit Consent
Should be Empty: