Address

City/State/Zip

Phone

Email

When would be a good time for my assistant to contact you?
Select Morning Afternoon Evening

How long is your natural hair?

How would you rate the health of your natural hair? (1 being poor-5 being excellent)
Select 1 2 3 4 5

How long is your hair in the crown of your head?

How would you rate your pain tolerance? 
Select Low Medium High

Please explain what is most important to you about your new extensions

How soon are you looking to have your extensions installed?(please note the waiting list can vary between 2-4 weeks)

Are you aware that there is a consultation fee of $50.00 that can be applied towards your extension balance. 
Select Yes No

When is a good day to set you up with a consultation
Select Tues 9am-10am Wed 9am-10am Thursday 5pm-7pm Friday 9am-10am Saturday 3pm-4pm

If you will be coming in from out of state will you be needing travel arrangement information?
Select Yes No N/A

How did you hear about Trayce Madre
Select Friend Flyer Radio Internet Google Yahoo Afrohair.com Other

Other: Please Explain