TOP ARLINGTON TX HAIR SALON SPECIALIZING IN HAIR THINNING -HAIR GROWTH - HEALTHY BLACK HAIR CARE
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    CONFIDENTIAL Hair Loss/Restoration Consultation Questionnaire

    Please fill out as accurately as possible and completely, so I can better serve your needs.  Thank you.

    ​Briefly give us your background story of hair loss symptoms and experience


    Medical History


    Females Only


    Males Only


    NUTRITION
    CONDITIONS OF THE SCALP
    If yes, in each box below, list your medication, symptom/diagnosis & how long you've been taking medication.

    HEREDITARY
    RELATIVES
    What are your goals and expectations? 

    Max file size: 20MB
    You can upload a visual photo of your hair loss to further help me prepare for our consultation.
    Max file size: 20MB
    You can upload a visual photo of your hair loss to further help me prepare for our consultation.
    Max file size: 20MB
    You can upload a visual photo of your hair loss to further help me prepare for our consultation.
    Max file size: 20MB
    You can upload a visual photo of your hair loss to further help me prepare for our consultation.

    Consent for Treatment 
    I am being evaluated by Blessings Beauty and Hair Restoration Center and understand I will first undergo a comprehensive preliminary evaluation by an experienced hair loss consultant.  This preliminary evaluation will include a complete and thorough medical and hair loss questionnaire, a scalp evaluation if available which includes standard medical photography (no face shown), and microscopic photography for which I give consent.  I also understand that although Blessings Beauty and Hair Restoration Center has had many very successful clients, each client is different and like any medical or cosmetic treatment, results will vary depending on a large number of factors.  I acknowledge it is my responsibility to inform Blessings Beauty and Hair Restoration Center of any changes in my medical condition no matter how slight and agree to read all product labels and treatment information provided to me so I can understand my treatments and get the best possible results.

    I understand some general recommendations will be made based on the initial consultation.
Submit
Blessings Beauty Center
2611 S. Cooper St., #200
Arlington, Tx 76015

682-323-2940
www.BlessingsBeautyCenter.com

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Arlington Healthy Hair Salon
Arlington, Texas
Advance Healthy Hair Solutions in DFW - Arlington, Texas offers the latest, most natural healthy hair solutions,natural hair, relaxed hair, hair color, hair cuts, hair extensionsand healthy hair  treatments.
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  • HOME - Healthy Hair Salon-Arlington Tx DFW
    • Meet Kendra Timmons - Owner
  • Our Work
  • Hair Loss Services
  • Contact