FREE Treatment Evaluation
Tell us a bit about your self so we can determine if Ultratress is right for you.
Complete our evaluation form and click the submit button. We will contact you with the best solutions suited to your hair condition.

1) Current age

Comments (are there any details you'd
like us to know):

2) Your current hair style? Long Short

3) Which description best typifies the condition of your scalp? (choose one)

Oily

Dry

Flaking

Normal

4) Which of the following treatments have you had done to your hair in the past year?
(check as many that apply)

Color

Straightening

Perm

Hair Extensions

5) What is the texture of your hair?

Thick, curly

Thick, straight

Thin, curly

Thin, straight

6) Have you noticed any thinning of your hair in the past year? Yes No

*Asterisked items are required

First Name*

Last Name*

Phone*

Best time to contact you?

Street address*

City*

State*

ZIP*