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Tricho Alopecia Solutions

Finest Hair Replacement & Hair Shop

Clients Name:

Adress:

Post code:

Phone:

Email:

System base type:

Attach photo?

Head Circumference in Inches:

Style below:

1Left Crown

2Right Crown

3Center Crown

4Left Part

5Right Part

6Center Part

7Pompadour Freestyle
All back / All front

Hair length:

Waves/Curls:

Straight: *

Slightly wave: *

Light wave: *

Afro: *

Tight afro: *

Hair density:

low: L; *

Medium: M; *

Medium Heavy: MD; *

Heavy: H; *

Frontal Hairline:

Temples:

Crown:

Back:

Hair length:

Type of hair:

Your Hair Ethnic Origin is:

Hair color:

Attach Sample?

Yes No

Attach old hair system:

Yes No

Highlights:

Baby hair in front:

Yes No

Base color:

Any allergies?

Any allergies In special to polyurethane?

Special instructions:

Sign:

Date:

Home
Women Hair Loss Conditions
Women Hair Solutions
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Children Hair Loss Solutions
Hair Replacement Course
Shop
Order Form
How to make a mould of your head
Links
About Us

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