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Hair consultation
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13
Questions
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1
What is your name?
First Name
Last Name
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2
Hair Type
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3
Your hair type
Which of the above options is the closest to your hair pattern?
1
2b
2a
2c
3a
3b
3c
4a
4b
4c
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4
Scalp :
your scalp condition can help determine what is lacking and needed for nourishment
Oily
Dry
Itchy
Dandruff
Psoriasis, eczema
Alopecia
No issues
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5
Select all that apply to you (all are contributed to hair loss reasons)
Taking Medications
Health issues (thyroid, cancer, malnutrition, Covid ...)
Stress
Hormones- menopause, postpartum
Weight loss or gain
DHT hormone
Recent surgery- local or general sedation
Trauma
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6
How often do you shampoo your hair?
Every day
Every other day
2 times a week
Once a week or less
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7
For Men, do you have facial hair that you need care routine ?
Beard/ facial hair
dry skin itchy
oily skin
Need skincare routine
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8
You want to improve:
boost hair growth
volume
frizz control
damage repair
manageability
curls definition
healthy hair/ longer hair
Balance my scalp oily or dry
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9
Which country are you from?
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10
your phone number?
Please enter a valid phone number.
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11
Your Email
example@example.com
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12
**Pay attention to the pricing and how long the bottles last in this image**
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13
Who should I thank for referring you to here?
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