New Client Consultation From

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Full Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
Please enter a valid phone number.
3
Email Address* This field is required.
example@example.com
4
State of Residence* This field is required.
Street Address
Street Address Line 2
City
State / Province
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5
We are located in Fairburn, Ga (Near Atlanta).Would you like to proceed in visiting us at our Fairburn location?
6
Although we were previously booked into 2026, are you interested in one of three new openings, no consultation required?
Yes
7
How did you hear about our service?* This field is required.
Please Select
Please Select
Friend or Family Referral
Online Search
Social Media (Instagram, Facebook, etc.)
Advertisement (Flyer, Banner, etc.)
Other
8
Have you previously used hair extensions?* This field is required.
Yes
No
9
Reasons for stopping previous hair extension treatments (if applicable)
10
If yes, what methods have you used before?
Please Select
Please Select
Clip-ins
Sew-ins
Glue-in Extensions
Tape-in Extensions
Fusion Extensions
Other
11
In certain cases of advanced hair loss, we may recommend an adhesive-based foundation to provide support for styling or enhancements. This process can involve professional-grade tapes, adhesives, and related materials. Reactions can vary, and while irritation is rare, the provider is not liable. Do you consent to proceed with this approach? ** This field is required.
Please Select
Please Select
Thinning Hair
Patchy Hair Loss
Diffuse Hair Loss
Receding Hairline
Other
12
Are you currently using any adhesives or bonding agents for hair extensions?* This field is required.
Yes
No
13
14
Do you have scalp sensitivity or allergies?* This field is required.
Yes
No
15
Main areas of hair loss* This field is required.
Please Select
Please Select
Crown
Hairline
Sides
Nape of Neck
All Over
16
Do you have any of the following conditions?
Alopecia
Allergies
Cancer
Psoriasis
Other
17
I understand this is a temporary hair loss solution, and everyone must find the right technique for them. Are you willing to try this approach to see if it works for you? *
Yes
No
18
Are you ready to proceed with our specialty extension service for new clients? This is an all‑inclusive investment $1250 for first time clients that includes premium hair and a private, one‑on‑one setting.A virtual consultation is REQUIRED for all first guest.
Yes
19
At Juney Bees, we are dedicated to providing a welcoming, uplifting, and respectful environment for both our clients and staff. We deeply value mutual respect, kindness, and serenity. Can you commit to treating all staff with respect and kindness? ** This field is required.
Yes
No
20
Do you agree to share your results and photos for promotional purposes?* This field is required.
Yes, I agree
No, I prefer to keep my results private
21
Upload photos of YOUR HAIR with no extensions from Different Angles (front, side, back)THIS STEP IS REQUIRED to be approved for services.* This field is required.
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Select files to upload
Max. file size: 10.0MB
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22
File Upload
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Max. file size: 10.6MB
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23
File Upload
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24
File Upload
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25
Inspiration Photo I’m
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Max. file size: 10.6MB
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26
I acknowledge that I have read the services and policies on JuneyBeesTotalCare.com and agree to the terms and conditions, including payment liability and the potential use of adhesives if necessary* This field is required.
Yes
27
If approved as a client, when would you like to schedule an appointment? *
28
PLEASE READ!To proceed with your virtual consultation, the full payment of $150 must be submitted alongside the completed form. The form will only be APPROVED once the payment BELOW is received. Please ensure both are submitted in their entirety to secure your consultation. Thank you for your understanding! Preferred scheduling timeline for consultation?
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Within 1 week
Within 2 weeks
Within 1 month
Flexible
29
Please specify your preferred date and time for consultation between Tuesdays and Thursdays (if any)
30
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ORDER SUMMARY
Total costUSD
(Virtual Zoom)
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