Constance Jean Walsh - Human Hair Wigs & Hair Pieces Hand Made & Designed By
Trichotillomania Hair Pulling Wigs & Hairpieces
 Hair Pieces/Hairpieces,Hair Wigs to help stop hair pulling or Trichotillomania
Teens/Teenagers Trichotillomania/Children Trichotillomania/Adults Trichotillomania Custom Wigs & Hair Pieces to Prevent Hair Pulling.
 
See Client Photos Below This Form
Trichotillomania:
Due to the request of our client's we are not displaying additional clients with the devestating hair loss from hair pulling.
Name of Person Inquiring:
Contact Form Trichotillomania Hair Piece or Wig
Age
Male or Female
How many years / months have you had Trichotillomania?
Have you tried other types of hair replacement methods?
What types of hair replacment methods have you tried?
If you checked any of the above, we would like to hear a short version of your experience with the above method.
Are you currently seeking Therapy or are currently in regarding your Trichotillomania?
If you were able to stop pulling what would your life be like? If you dont want to answer just put N/A in the box below. :)
If you could have any type of hair how would you describe it?
Thicker
Fuller
Longer
Different Color
Strait
Curly
Bodywave
Big Curls
Lots of layers
All one length
A couple of layers
If you could have a celebrity's hair, who would you choose? Who can you relate to? (ex. I would love to have Jennerifer Annistons Hair)
Why did you choose to visit Constance Jeans Walsh's today?
Would you like us to call you or do you prefer us to email you?
Yes please call me to shedule a conultation!
Yes please email me more info
No calls yet. I am just inquiring
Please be discreet when you call.
Please call me! I do have more questions :)
Best Time to Call You
Is there a specific day you would like your appointment scheduled? We will need at least one weeks notice prior to booking your appointment.
Do you have phots of yourself avaible to send to a Wiggin Out staff member to review? We need your pictures so we may assess your hair needs prior to your appointment. The more pictures you send up the more we are able to help you have the "hair of your dreams"
Address: (we need complete address)
Email Address:
Phone Number:
Are you on any social websites such as Facebook, My Space ect?
What sports/ social activities / hobbies have you discontinued since you have had trichotillomania?
What sports/ activities/ hobbies would you like to pursue if you felt good about yourself again?
Last question. :) Are you
Married
Single
In a relationship
I dont feel I can be in a relationship now
I would like to be in a relationship
I am too young to date!
My parents wont let me date :) :)
I am boy crazy LOL!
 
 
 
Hair Wigs, Hairpieces Trichotillomania Hair Pulling Wigs & Hairpieces
 Hair Pieces/Hairpieces,Hair Wigs to help stop hair pulling or Trichotillomania
Teens/Teenagers Trichotillomania/Children Trichotillomania/Adults Trichotillomania Custom Wigs & Hair Pieces to Prevent Hair Pulling.
 
Hair Wigs, Hairpieces Trichotillomania Hair Pulling Wigs & Hairpieces
 Hair Pieces/Hairpieces,Hair Wigs to help stop hair pulling or Trichotillomania
Teens/Teenagers Trichotillomania/Children Trichotillomania/Adults Trichotillomania Custom Wigs & Hair Pieces to Prevent Hair Pulling.
 
Hair Wigs for Trichotillomania Hair Pulling Wigs & Hairpieces
 Hair Pieces/Hairpieces,Hair Wigs to help stop hair pulling or Trichotillomania
Teens/Teenagers Trichotillomania/Children Trichotillomania/Adults Trichotillomania Custom Wigs & Hair Pieces to Prevent Hair Pulling.
 
 
 
Human Hair Wigs Designed By Constance Jean Walsh
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7361 Melrose, At Sweet 9
Los Angeles , CA , 90046 USA
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Phone 8777699447