Name
*
First Name
Last Name
Email
*
example@example.com
Is your scalp dry or oily?
*
Dry
Oily
Combo
Normal
Is your scalp itchy or flaky?
*
Itchy
Flaky
Neither
Do you have sensitive skin or a sensitive scalp?
*
How often do you wash your hair?
*
Is your hair texture
*
Fine
Coarse
In between
How dense is your hair?
*
Thin
Medium
Dense
Is your hair:
*
Straight
Wavy
Curly
Is it frizzy?
*
Yes
No
Which do you need more of?
*
Moisture
Volume
Do you have split ends?
*
Yes
No
Is your hair damaged?
*
Yes
No
Is your hair colored or lightened?
*
Colored
Lightened
Have you had any chemical processes done, other than color? (If so, please list).
*
How do you dry your hair?
*
Blow dry
Air dry
Both
Do you use a curler or straightener?
*
Yes
No
Do you have any allergies? (If so, please list them.)
*
What do you currently use for hair products? (Brand and type.)
*
What type of water do you have?
*
Well
City
Would you like more information on how you could make money by using these products and sharing them?
*
Yes please
No thank you
In the future
Are you interested in anti-aging skincare?
*
Yes
No
Maybe later
How about wellness products?
Yes
No
Maybe later
Thanks so much, I’ll be in touch soon!
While your waiting why not head back to my main page and check out my other links! Xx
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