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Raleigh, NC Hair Extension Boutique
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Hair Replacement Methods
Reason for Hair Loss
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Address
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
What is your DESIRED hair length?
Below ear
At shoulders
Past shoulders
Mid-back
No length, just thickness
None of the above
What is YOUR hair length?
Above ear
Below ear
Jawline
Shoulder length
Below shoulders
Mid-back
Other
Do you experience any hair loss?
Yes
No
What type of hair loss do you experience?
Alopecia areata
Traction alopecia
Telogen effluvium
Anagen effluvium
Trichotillomania
Tinea capitis
Scleroderma
Syphilitic alopecia
Female pattern hair loss
Male Pattern hair Loss
How would you describe your hair texture?
Broken with flyaways
Baby fine
Fine
Average
Very thick
Type of hair?
African-American
Asian
Caucasian
Indian
Spanish
Other
Describe your hair pattern
Naturally straight
Relaxed press
Wavy
Big curl
Medium curl
Small curl
Jerri curl
Frizzy
Afro
What color is your hair?
Platinum blonde
Light blonde
Dark blonde
Brunette
Light brown
Red
Black
Gray
Other
Have you ever worn hair extensions?
Yes
No
If yes, which type(s)?
Fusion
Hair locs
Dome
HairDreams
Greatlength
Megahair
Ultress
Braids
Weave
Clip Ins
Hair piece
Intergration
Wig
Toupee
So Cap
Cinderella
Would You Like A FREE Consultation?
Yes
No
How did you hear about Glam?
Search engine
Referred
Triangle Style
Midtown Magazine
Cary Living
News & Observer
Other
Other
Please be specifc
How soon would you like to recieve your NEW look?
Immediately
Within 30 days
Within 60 days
Not sure
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