My Happy Hair Intake Form

Name *

First

Last

Address: (City, State, Zip) *

When is your appointment scheduled for: *

What is the nature of your appointment: *

Hair loss due to a medical reason
Looking to sport a new look

If hair loss is due to a medical reason, please share your diagnosis and when you were first diagnosed: *

Are you hoping to find a hair solution that closely resembles the way your hair looked before you lost it? *

If you checked yes, please upload a photo that shows your natural hair before you experienced hair loss. This helps us match your previous color, length, and style as closely as possible *

If your previous hair wasn’t the look you loved, are you open to trying something new? *

If you answered yes, what color are you interested in? *

What length would you like? You don’t need to know inches. Just let us know chin length, shoulder length, middle of your back, etc *

What kind of hair are you interested in? Synthetic, real hair, Remy hair or a blend? (see descriptions on our FAQ page) *

Do you prefer bangs? *

If you have a picture of a wig you just love, upload it here *

Are you undergoing any treatment now we should know about? *

Do you have any scalp sensitivities? If yes, please explain. *

Will you be wearing your wig daily or only on occasion? *

interested please know

Do you wear eyeglasses? *

Have you worn alternative hair in the past? If so, what kind? *

Please let us know if there’s anything additional we should be aware of to help ensure your appointment feels relaxed, comfortable, and well-prepared. *