Hair Extension Adhesive Removal Form
Please complete this form to request a hair extension adhesive removal appointment and help us provide the best service for your needs.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Type of Hair Extensions
*
Please Select
Tape-In
Keratin Bond
Micro-Link
Sew-In/Weft
Clip-In
Other
Type of Adhesive Used
*
Please Select
Keratin Glue
Tape Adhesive
Micro-Link/Beads
Sewing Thread
Other
Area(s) for Removal
*
Full Head
Partial (Front)
Partial (Back)
Partial (Sides)
Other
Do you have any scalp sensitivities or allergies?
*
No
Yes (please specify below)
If yes, please describe your sensitivities or allergies
Preferred Removal Method (if any)
Please Select
No preference
Solvent-based removal
Oil-based removal
Manual removal
Other
Preferred Appointment Date and Time
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Aftercare or Special Instructions
Submit Request
Should be Empty: