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MESH INTEGRATION INQUIRY

First name

Last name

Phone

Birthday

Month

Day

Year

By checking this box, I agree to receive texts from DanieLA Hair at this mobile number. Message and data rates may apply. To opt-in you agree to get appointment reminders via text. For help or to opt-out send an email to contact@danielahair.com

What are your biggest areas of concern?

Do you suffer from any medical conditions that cause hair loss?

Do you take any medications that could cause hair loss?

Have you recently noticed any change with your hair including excessive shedding, breakage, etc?

Have you recently experienced any major life changes or events? (Postpartum, significant weigh loss, post chemotherapy)

Do you ever notice any imbalances with your scalp? (Itching, flaking, heavy oil production)

What is your current hair wash cycle?

What products do you use at home?

How often do you heat style/ blow dry?

How active are you / do you wear your hair up often? How often?

Have you had any chemical services performed in the last 6 months?

Upload a photo of your area(s) of concern

What are your expectations of the integration system?