Intake form

Help us serve you better

Name *

Email address *

Phone number

Preferred appointment date

Have you had any previous scalp micropigmentation treatments?

What is your primary concern regarding your scalp appearance?

Please select at least one option.

Thinning hair

Bald spots

Uneven hairline

Scarring

Do you have any allergies or skin conditions?

How did you hear about permanent fibers?

Which service or services are you interested in?

Please select at least one option.

Scalp micropigmentation

Hairline restoration

Bald spot concealment

Additional questions or comments

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Permanent Fibers