HAIR CONSULTATION FORM
Please answer all of the following questions to the best of your ability, and with as much detail as possible. I will reach out to you within 24-48 hours to discuss your results.
Name:
First Name
Last Name
Email:
example@example.com
Phone number and/or Instagram handle:
Preferred method of communication:
Phone (text)
Instagram DM
Email
Other
How would you describe the density/thickness of your hair?
Very thin
Thin
Medium
Thick
Very thick
Which hair type shown in the image below resembles your hair the most?
1
2a
2b
2c
3a
3b
3c
4a
4b
4c
None of the above
Image from mindbodygreen.com
Which option best describes your scalp?
Normal
Moderately oily
Moderately dry
Extremely oily
Extremely dry
A combination of oily and dry
Which of the following do you experience? (check all that apply)
Dry flakes on scalp (aka dandruff)
Oily flakes on scalp (aka dandruff)
Bald or thin spots on scalp
Hair loss (more than 100 hairs a day)
Breakage or damage
Weak or brittle hair
Dryness
Split ends
Frizz
Dull or fading color
None of the above
Other
How do you prefer to style your hair?
Have you ever dyed your hair?
Yes, in the past.
Yes, and I still dye it regularly.
No.
Do you use heat on your hair? (select all that apply)
Yes, I blow dry my hair.
Yes, I use hot tools (curling iron, flat iron, crimper, etc.)
No, I only air dry.
Please upload a photo of your hair here if possible:
Browse Files
You may also send me a photo over text or DM.
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Describe your dream hair:
What would you like to change or improve about your hair?
Are you currently taking any supplements to improve your hair health?
Yes!
No.
No, but I am interested in learning more about them.
Which of the following are you interested in? (select all that apply)
Purchasing 1-2 products to start
Purchasing a full system with 3+ products at a discounted rate
Becoming a product ambassador
The business opportunity
I'm not 100% sure yet
FREE tips and tricks for healthy hair
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