Please fill out the appointment request and intake form below. Answer each question to the best of your knowledge and also let us know what your primary hair and/or scalp questions or concerns are. As soon as we receive your appointment request you will be contacted to confirm your appointment. 

Service Request*
High Blood Pressure*
Thyroid Condition*
Heart Disease*
Allergies *
Vitamin Definciencies*
Hair Information: Check all that apply
Hair Strands
hair shedding
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Thank you for contacting us. We will get back to you as soon as possible to confirm your appointment or answer any questions you may have.