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18
Questions
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1
Name
*
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First Name
Last Name
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2
Email
*
This field is required.
example@example.com
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3
Thickness of hair
Very thick
Thick
Medium
Thin
Very thin
Very thick
Thick
Medium
Thin
Very thin
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4
Hair texture
Straight
Wavy
Curly
Coils
Coarse
Straight
Wavy
Curly
Coils
Coarse
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5
Is your hair dry?
YES
NO
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6
Do you have oily roots?
YES
NO
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7
How often do you wash your hair?
Every day
2-3 times a week
Once a week
Every 2 weeks
Once a month or less
Every day
2-3 times a week
Once a week
Every 2 weeks
Once a month or less
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8
Any frizz?
YES
NO
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9
Do you have dead/split ends?
YES
NO
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10
Scalp health
Dandruff
Itchy
Greasy
Flakes
Other
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11
Do you currently have a relaxer/perm
YES
NO
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12
What brand of shampoo do you currently use?
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13
What do you want more of in your hair?
(Bounce, Volume, Shine, Thickness, Length, etc.)
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Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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14
What do you want less of in your hair?
(Oil, frizz etc.)
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Small
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quote
Created with Sketch.
Ok
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15
What is your primary hair concern?
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Small
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quote
Created with Sketch.
Ok
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16
Phone Number
For texts only
Area Code
Phone Number
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17
Instagram username
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18
How would you like me to contact you?
*
This field is required.
Email
Text
Instagram Direct Message
Email
Text
Instagram Direct Message
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