Boost Your Confidence: Hair Replacement Pre-Consultation Survey
To get started, please take a few moments to complete this survey. Your valuable input will help us understand your needs and preferences better
Step 1 of 5
PC-S What kind of hair loss do you have
*
Receding
At the Crown
Patchy Baldness
All Over
Step 2 of 5
PC-S How prominent is your hair loss in that area
*
A little (Only I notice it)
Some (Those close to me notice it)
A lot (Its obvious to everyone)
Step 3 of 5
Which of the following best describes your hair type
*
Straight
Curly
Afro/Kinky
Other
Step 4 of 5
PC-S When would you prefer to have the service done?
*
ASAP
In the next 1-2 weeks
Within the next 30 days
In the near future, no rush
Step 5 of 5
First Name
Last Name
Email
*
Phone
*