First & Last name
*
How would you like to be contacted?
*
Instagram
Email
Phone
Text
What's your email?
*
Phone number
*
Birthday
*
-
Month
-
Day
Year
Date
Instagram name?
*
What is your current hair color?
*
Do you treat your hair?
*
Yes
No
Sometimes
What is your natural hair like?
*
Straight
Beach waves
Curly
Coily
Other
What is your current hair length?
*
Very short
Short
Shoulder Length
Long
Very long
Do you have thick or thin hair?
*
Thick
Thin
How do you normally style your hair?
*
Air dry- Natural
Styled with heat
Both
Do you suffer from dry/flaky/itchy scalp?
*
Yes
No
Sometimes
Do you have sensitive skin?
*
Yes
No
Do you have oily roots?
*
Yes
No
How often do you wash your hair?
*
Everyday
Every 2 days
Once a week
Twice a week
What are your main concerns for your hair? (Check all that apply)
*
Dry/coarse
Oily hair
Frizz
Thinning/balding
Split ends
Other
If you checked dry/coarse hair, describe where:
Any other concerns? (excess shedding, dandruff, ect...)
If you have any balding/thinning, give details...
What are your hair goals? (Check all that apply)
*
Hydration
Volume
Growth
Shine
Thicker/fuller hair
Smoother & Silkier hair
Other
What's the most comfortable price range for you?
*
$85-$100
$100-$150
I have no budget
I'm like more info on:
Skincare
Wellness
Making extra income
Pet line
Kids line
Submit
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