What is your name?
*
First Name
Last Name
Phone Number
*
-
Area Code
Phone Number
What is your Instagram Handle?
*
What is your Hair Type?
*
Straight
Wavy
Curly
Coiled
What is your Hair Density?
*
Very Thin
Thin
Inbetween
Thick
What is your Hair Length?
*
Pixie
Short/Shoulder
Medium
Long
Extra Long
Is your Scalp
*
Oily
Dry
Normal
Other
Does your scalp gets oily the day after washing your hair?
*
Yes
No
Sometimes
Is your hair colored?
Yes
No
How often do you wash your hair?
*
Every Day
Every Other Day
Twice a Week
Once a Week
My hair is
*
Dry
Brittle (Breaks off Easily)
Limp
Frizzy
Damaged from Heat
Damaged from Coloring
Thinning
Receding Hairline
Post Partum Hair Loss
Oily
None of the Above
Other
How often do you apply heat?
*
Never
Once in a while
2-3 Times a week
Daily
How do you style your hair?
*
Air Dry
Air Dried and Styled
Blow Dried and Styled
What products do you use to wash/style your hair?
*
What are your hair concerns?
*
What are your hair goals?
*
What is the best way to contact you to discuss your results?
DM Me (Instagram)
Text Me
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