Medical Wig Consultation Form Elite Hair & Beauty Supply LLC CRANIAL PROSTHESIS; Laketta Gill PHONE: (228) 337-2834 EMAIL: info@elitehairbeauty.com personal Information CLIENT'S NAME ADDRESS SUBURB P/CODE PHONE EMAIL AGE I.D. SIGHTED Yes How do you hear about us ? FriendsSocial media Other: Opt-in for email list to receive information and offers YesNo Your responses here will help us best prepare for your wig consultation appointment and ensure we suggest the best pieces for you What hair type of wig are you interested in? SyntheticHeat-Friendly SyntheticHumanNot sure Other: What hair Texture or Wig are you interested in? StraightWavyLoosely CurlyCurlyAfro-TextureNot sure Other: What length of wig are you interested in? ShortChin-LengthShoulder-LengthMid-Back LengthLower-Back LengthNot sure Other: Are you looking for a wig with bangs? YesNoMaybe Other:
