Picky Pam at the Beach - Hawaii
NOTE:  Dreadlocks, hair extensions, and/or extremely coarse hair, open sores and/or extremely severe (over 1,000 estimated nits)  might not be suitable for our products and treatment.  Our treatment requires a child to sit on their own for a minimum of 1 hour.
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Adult/Parent's (FIRST) Name *
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Child's Name 1 *
Child's Age 1 *
Child's 1 Gender
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Treatment (For Office Use Only)
Child's Name 2
Child's Age 2
Child's 2 Gender
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Child's Name 3
Child's Age 3
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Treatment (For Office Use Only)
Child's Name 4
Child's Age 4
Child's 4 Gender
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Does Child 4 have access to cell phone/tablet
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Treatment (For Office Use Only)
Product (For Office Use Only)
Adult Treatment (For Office Use Only)
You are done.  Hand tablet back to Picky Pam Staff for them to begin head check.  Please DO NOT HIT SUBMIT
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