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Ready to experience expert hair care in a private and relaxing setting? Booking your appointment is easy! Simply contact us to find a time that works for you. Whether you're looking for a consultation, a custom hairpiece fitting, or a refreshing new style, we’re here to provide the personalized attention you deserve.
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Hair Restoration & Replacement Consultation Form
Thank you for choosing Makeover’s Hair Restoration & Replacement Center LLC. Please complete this form prior to your consultation.
Client Information
Name: _______________________________
Phone: ______________________________
Email: _______________________________
Preferred Contact:
☐ Call ☐ Text ☐ Email
Hair & Scalp Concerns
☐ Thinning Hair
☐ Hair Loss
☐ Bald Spots
☐ Receding Hairline
☐ Alopecia
☐ Scalp Irritation
☐ Excessive Shedding
☐ Other: __________________
How long have you experienced this concern?
☐ Under 6 Months
☐ 6–12 Months
☐ 1–3 Years
☐ 3+ Years
Previous Hair Restoration/Replacement Services?
☐ Yes ☐ No
Services Interested In
☐ Hair Restoration
☐ Hair Replacement
☐ SMP
☐ Microchanneling
☐ Infrared Light Therapy
☐ High Frequency Therapy
☐ Scalp Detoxification
☐ Consultation Only
Medical & Hair History
☐ Scalp Sensitivities/Allergies
☐ Medications Affecting Hair Growth
☐ Physician Care for Hair Loss
☐ Hormonal Hair Loss
☐ Stress-Related Hair Loss
☐ Traction Hair Loss
Hair Goals
Consultation Preference
☐ In-Person
☐ Virtual
Preferred Days/Times:
☐ I understand results vary and a consultation is required before services are recommended.