HAIR EXTENSION/WEAVE CONSULTATION FORM

Date of Consultation: _______________________ Name: __________________________________________________________ Address:_________________________________________________________ Phone: ___________________ Email: _________________________________ Birthday:______________________ Sex: F ____ M _____ How were you referred? � Google � Yahoo � Website � Craigslist � Family or Friend � Backpage � Yelp � Hotfrog � Other, __________________ 1. Have you ever had hair extensions before? If so circle which methods: � Fusion � Microlinks/Microtubes � Bonded Weave � Sewn-in Weaves �Seamless Wefts � Braidless Weave Method � Seamless wefts (tape method) � Toupee � Other: ______________ 2. If yes, did they meet your expectations? If no what didn’t you like about the method? 3. Did you have any problems and/or damage with your previous hair extension method?

4. Do you have a sensitive scalp or skin? 5. If inquiring about a braided method, does it hurt when you get cornrows? 6. Are you allergic to any adhesives such as latex glues or keratin? 7. Skip if your hair is not chemically straightened. Do you relax your hair at home or have it professionally done? 8. Are you sensitive to or allergic to any hair care or skin product? 9. What method of hair extension application are you most interested in? 10. What are your reasons for wanting hair extensions? Fullness/Length? 11. How often do you shampoo and condition your hair? 12. What products do you use to shampoo, conditioner, and maintenance products do you use on your hair? 13. How would you describe your scalp: dry, normal, oily? 14. How would you describe the natural texture of your hair, please check all that apply: � Straight � Thin � Curly � Extremely Curl �Wavy �Thick � Extremely Thick � Coarse � Fine 15. Are you aware of the maintenance involved in wearing hair extensions (i.e special products, special care of hair, monthly touch-ups) ? Maintenance tips are available at www.glamouryou.net

16. Are you currently taking any medication that has side effects that can cause hair thinning and/or hair loss? Do you have thyroid issues? Or vitamin deficiency issues? 17. Do you have now, or have had in the past, any problems with hair loss (shedding, breakage, balding, alopecia, thinning hair line, etc)? If yes have you seen a dermatologist? 18. Tell me about your hair, please check all that apply: � Relaxed � Permed �Chemically Straightened � Dry � Damaged �Weak � Breaking � Shedding � Healthy � Strong � Bleached � Other: ______________________________ 19. How do you rate your hair: � Excellent � Good � Fair � Bad Condition 20. Do you have any color in your hair? When was the last time you had it applied? Is it a permanent? 21. Do you have any other questions & concerns about hair extensions? 22. Is there anything else you would like to share? By signing this consultation form, I certify that the above information I have provided is true and that I have received the 'Home Care Instructions' which is also available on the website www.glamouryou.net. I also agree to adhere to the advice given to me. I will not hold the stylist responsible for any damage or injury caused by my failure to adhere to the information & instructions given to me. I understand that regular maintenance is required to keep my extensions at their best and removal should be performed by a licensed professional within 3

months of the installation date. I also acknowledge that all the work is being done by a licensed

hair care professional and at their discretion. I agree not to hold Glamour Hair Extensions

Boutique, a subsidiary of Rogue Beauty Concepts LLC, their employees, representatives, agents,

or authorized dealers of any adverse effects, or any less than desirable results. ____________________________ Print Name ___________________________ Client Signature: ______________________________ Date: ______________________________________________________________________________________ Below line for stylist use only ________________________________________________________________________ Extension/Weave Care Form Given to Client: Yes _____ No _____ Method: _______________________________________ Brand of hair used: ____________________ Color required: ____________________ Length:

Maintenance Recommendation /Service Notes