Contact Michelle's Hair Enhancement
Please complete this confidential form so we may better serve you:
Name:
Email address:  

Address:
Address 2:

City:    State:   Zip:

Area Code:    Home or Cell Phone:    Business Phone:

To help us better serve your needs, please tell us if you are a :


1. How did you hear about Michelle's? (Check all that apply)
A. Local Newspaper
B. TV Commercial
C. Internet Advertisement
D. Friend
E. Yellow Pages
F. Local Magazine

2. What are your reasons for contacting Michelle's? (Check all that apply)
A. Beginning Hair Loss
B. Hair line recession
C. Crown Thinning
D. Unhappy with past or current hair service
E. Unhappy with my hair

3. What type of hair are you interested in (Check all that apply)
A. Single Custom Hair Replacement
B. Hair Replacement System (ongoing)
C. Hair Weaving
D. Hair Extensions

I would like more information about...



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