New Clients

New Client Form

Your journey back to healthier and fuller hair starts here

We’re so glad you found OlyHair!
We look forward to helping you fall in love with your hair all over again.

Ready to book your first consultation?

If you are ready to begin your hair restoration journey, please use the contact form below to
request a Hair Loss Consultation. Please plan for an hour-long visit. ($149)

First:
To secure your appointment, we require a credit card on file. Please take a moment to complete the Jot Form. Note: You will not be entering your card information. We will take your credit card information over the phone at the time of booking.
Click Here for the Credit Card "Jot" Form. Once that is submitted, come back to this page and request an appointment. Thank you, and we look forward to serving you!

* Indicates required field

Client Name *

First

Last

Preferred Pronouns *

Is the client over 18? We cannot treat clients under the age of 18. *

Yes No

Email *

Cell Number *

Home Number *

How did you hear about us? *

What do you hope to achieve with this appointment? *

What do you think might be contributing to your hair loss? *

Other Comments *

Please upload photos of your hair below.

Front View *

Max file size: 20MB

Side View *

Max file size: 20MB

Back View *

Max file size: 20MB

Please READ and check the boxes below once you are ready to send this form *

I have attached my photos and I understand that I cannot be booked until you receive these I have submitted the Jot Form (link provided at the top of the page in red)

Submit

Once you press submit, it might take a few seconds to go through. You should get a confirmation on this page that it was sent.