Form

HAIR QUESTIONNAIRE
Name

First NameLast Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Date of birth:

MonthDayYear
Date
Describe your scalp- (Select all that apply)

DryOilyNormalFlakyItchySensitiveOther
How often do you wash your hair?

DailyEvery other dayBetween 3-4x a weekMore than 5+ days a weekOther
What best describes the texture of your hair (the thickness of each strand)

FineMediumThick and coarseUnsure
Which best describes your hair (Select all that apply)

DryVery dryFrizzyNot FrizzyHealthyBrittle and breaks easilyLimp and lifelessProcessed with a treatmentProcessed with color or bleachSplit endsOther
Which best describes your type of hair?

CurlyWavyStraightCoilyOther
Which best describes the length of your hair?

Very shortshort (from the chin up)Shoulder lengthLongVery long
How do you typically style your hair?

Air dryAir dry then use flat iron/ curling toolBlow dryBlow dry then use flat iron/curling toolSome days air dry, some days blow dryOther
What is your current hair routine?
What kind of shampoo/ conditioner are you using? Do you use a leave in conditioner? A root lifter or blow dry?
Do you have any hair loss or thinning/post partpartum hair loss?

NoThinning all overPostpartum hair loss all overPostpartum hair loss, bald spotsBald spotsSevere balding
What is your main hair concern?
ex: postpartum hair loss, very dry, limp, no volume, split ends
What is your main hair goal?
ex: I want more volume, healthier hair, shinier, silkier hair, hydration, I want my hair to grow longer, I want my thinning spots to fill in
What current hair products are you using?
Is there anything else I should know about your hair?
Are you allergic to:

SoyNutsBothOther
If you feel comfortable, please share a photo of your current hair! This will help me recommend the best products for your hair! :)

Cancelof
Are you interested in any of our styling/finishing products?

Dry shampooHair sprayDry texturizing sprayBlow out creamAir dry creamCurl creamSculpting taffyThermal shield heat protectantMagnifying mousseThickening sprayRoot lifterRejuveniqe OilDetangularIntense repair treatment
Are you interested in our color toning shampoos/conditioners?

BrunetteBlondePlatinum
Are you interested in our lash and brow growth serum?

YesNo
Are you interested in trying any other product lines? Select all that apply

Junior'sPetMen'sSkinWellness
THANK YOU SO MUCH!

I appreciate you taking the time out of your busy day to complete my hair questionnaire. I will get back to you as soon as possible with all the recommended hair products to start you on your new healthy hair journey!!

Erika Paggioli
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HAIR QUESTIONNAIRE