What is your name?
*
First Name
Last Name
Email
*
example@example.com
What is your Instagram handle?
*
Phone Number
*
-
Area Code
Phone Number
What is your birthdate?
*
/
Month
/
Day
Year
Date
What is your hair type?
*
Straight
Wavy
Curly
Coiled
What is you hair density?
*
Very Thin
Thin
Thick
In Between
What is your hair texture?
*
Frizzy
Dry
Frizzy/Dry
What is your hair length ?
*
Pixie
Short/Shoulder Length
Mid Length
Long
Is your hair color treated?
*
Yes
No
Is your scalp:
*
Oily
Dry
Normal
Other
How oily does your scalp get within two days of washing?
*
Not Oily
Somewhat Oily
Very Oily
How often do you wash?
*
Every day
Every other day
Every 3-4 days
Once a week
Is dandruff or flakiness an issue?
*
Yes
No
Somewhat
“My hair is...”
*
Dry
Limp
Frizzy
Brittle (breaks easy)
Damaged from heat
Thinning
Receding (receding hairline)
Damaged at the ends (split ends)
Chemically over-processed
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 prefer to style your hair?
*
Air-dried and styled
Blow-dried and styled
Only air-dried
Only blow-dried
Other
What products do you use to style your hair?
*
What is your biggest concern?
*
What are your ultimate hair goals?
*
What is your skin type?
*
Dry
Sensitive
Normal
Combination
Oily
My skin concerns include...
*
Acne
Sun Spots
Scarring
Age spots
Fine Lines/Wrinkles
Large Pores
Discoloration
Dark Circles
Puffy Eyes
Texture
Eczema
Psoriasis
Other
What products are in your current skincare routine?
*
What are your ultimate skin goals?
*
What product lines are you interested in?
*
Hair care Line
Skincare Line
Men’s Line
Kid’s Line
Pet Line
What are you interested in?
*
Purchasing the products
Becoming a partner. Earning an extra income (+30% off!)
Both
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