Name
First Name
Last Name
Please provide your Instagram and/or Facebook name
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What is your hair density?
Thick
Thin
Somewhere in the middle
What is your hair texture?
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Coarse (rough texture)
Fine (soft & smooth)
I’m not sure
What is your natural hair like?
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Straight
Curly
Wavy
If your hair is curly, do you ...?
Wear your natural curls
Use heat to straighten your curls
A little bit of both, sometimes embrace my curls, other times straighten or blow out
Do you have oily hair ? (Having to wash your hair within 1-2 days)
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Yes
No
Is your hair dry?
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Yes, but just the ends
Yes, throughout all of my hair
No
How often do you wash your hair?
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Daily
Every other day
Every 2-3 days
Every 4-5 days
Once a week or even more infrequently
Check all of the following that apply to your hair
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Frizz
Color damage
Heat damage
Split ends
Is your hair color treated?
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Yes, I get highlights/bleach
Yes, I color my hair darker
Yes, but only because of grays
No
How do you typically style your hair? Check all that apply
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Blow dry
Air dry
Straightener
Curling iron
Leave it naturally curly
Do you have any scalp issues? Please describe. (Ex: psoriasis, eczema, dandruff, oily scalp, sensitive scalp, etc.)
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Is thinning/balding a concern? If so, please describe (Ex: is there thinning throughout your hair, bald spots, receding hairline, etc.)
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What is your main hair goal? Deacribe your dream hair!
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Please list any allergies!
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Any additional comments you’d like to include:
Email address
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