Modern Nature Questionnaire

Welcome to Modern Nature Hair Care!

We are the #1 hair care company in North America, offering naturally based products that REPAIR, GROW and anchor the hair. We bring you the best of both science and nature that together creates the first and only clinically proven anti-aging hair care line in the world! We currently offer product in the United States, Canada, UK, Poland and Ireland!
We say "NO" to toxic ingredients such as...

Silicones, sulfates, parabens, phthalates, BHT, DEA/MEA, polyethylene glycol, phenoxyethanol, petrolatum, mineral oil, paraffin wax, triclosan, plastic microbeads, formaldehyde releasers, harmful colors and harmful fragrances. No animal testing.
We ARE...

Gluten free, vegan, Leaping Bunny certified and National Hair Loss Association approved.
Name

First NameLast Name
Email
example@example.com
Phone Number

Area CodePhone Number
Date of Birth

MonthDayYear
Date
Country of Residence
What best describes your scalp? Select all that apply.

drynormaloilyitchyflakysensitivescalp psoriasisOther
Which best describes your hair texture (how thick each strand is)

finemediumthick/coarsenot sureOther
Which best describes your hair density ( the amount of hair on your head)?

thin/ not a lot of hairmediumdense/a lot of hairnot sureOther
Which best describes your hair? Select all that apply.

frizzynot frizzydamagednot damagedbrittle/breakingoilylifelesstanglydryvery dryOther
Which best describes your hair? Select all that apply.

curlywavystaightvery shortshort ( above chin)shoulder lengthlongvery longOther
How often do you wash your hair?

Every dayEvery other dayEvery 3-4 daysEvery 5+ daysOther
Do you have split ends?

YesNoNot sure
What do you need more of , moisture or volume?

MoistureVolumeNot sureOther
How do you style your hair? Select all that apply.

Air dryBlow dryCurling iron or flat ironAir dry, then curling iron or flat ironOther
Do you have any hair loss? If so, which best describes your hair?

ThinningSome bald spotsSevere baldingPostpartum hair loss, all overPostpartum hair loss, bald spotsHair loss due to a medical reasonOther
What is your current haircare routine?
Ex: shampoo, conditioner, detangler, heat protectant, hair spray, etc.
What is your current favorite haircare brand?
What is your main hair concern and your main hair goal?
Is there anything else we should know about your hair?
Ex: extensions, recently bleached, prepping for an event, scalp conditions, swimmer etc.
Are you interested in any of these styling products?

DetanglerDry ShampooHairsprayLeave-in-conditionerRoot LifterThickening SprayAir Dry CreamBlow Out CreamThermal Shield Heat ProtectantColor Locking & Protectant SprayDry Texturizing SprayMagnifying MousseSculpting TaffyRejuvenique Oil IntensiveRejuvenique Oil Light
Are you interested in any color toning products?

Perfectly Platinum-purple shampoo & conditioner to brighten blonder and tone out brassinessBrilliant Blonde- yellow shampoo & conditioner to enhance golden tones and make blonde warmerBeautiful Brunette- brown shampoo & conditioner to keep brown rich in color
Are you allergic to nuts of soy?

NutsSoyBothNeither
If you are comfortable, please send me a photo of you hair using the button below.
Are you interested in products for skin, men, kids or dogs as well?

SkinMenKidsDogs
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Welcome to Modern Nature Hair Care!

We say "NO" to toxic ingredients such as...

We ARE...