HBS Alopecia & Hair Loss Inquiry Form
HBS Alopecia & Hair Loss inquiry form is to request information to help the stylist to better service each person according to their desire style.Thank you for booking with Hersheyblu Stylez and please fill out the inquiry form below. After completing, go to the booking tab and schedule the Blu Alopecia & Hair Loss Consultation of your choice. 
Name
How old are you?
What type of hair replacement are you interested in discussing? (please keep in mind that every hair solution is not applicable for every client.) 
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How long have you been experiencing alopecia or hair loss?
Do you know any history of alopecia or hair loss in your family? 
Have you been treated for hair loss and scalp problems? If so when and by whom. 
Please indicate which areas your hair loss affects you (check all that apply):
What 
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What other hair replacement alternatives or options have you considered?
Do you currently take medication?   If yes, please explain...
Have you been to the dermatologist?  If yes, what was your diagnosis? 
What type of activities or hobbies do you participate in regularly?
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Do you have activities or hobbies that causes sweating?  If yes, please explain 
What are your main goal?
If you have been advised by other professionals, why have you chosen myself.
Do you need someone (other than yourself) to assist in the decision to correct your hair loss?
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Are you able financially at this time , to do something about your hair loss?
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Are you generally in good health?
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Are you currently under a doctor's care?
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Have you had prior hair transplants?
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Check any of the following that you currently have or have had in the past. 
Do you have any type of blood disorders?
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Do cuts on your skin heals normally?
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Do you suffer with keloid skin?
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Are you allergic to hair glue.
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Brief description of your alopecia and hair loss issues and concerns you may have or pertaining information I should know about you.
Submit
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