Scalp & Hair Questionnaire

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Welcome to the new phrase of your scalp, hair, and beard care journey!We are the nation's #1 source skin (scalp) and hair health and wellness. Our vision is to cultivate skin (scalp) and hair wellness (well-being). To achieve this, we provide valuable resources like this questionnaire and a range of products dedicated to enhancing and sustaining their condition. The skin is the body's largest and most vital organ, along with the hair, the skin protects the internal systems and organs against external threats such as infections and injuries. Allow us to assist you in identifying and comprehending the state of your skin (scalp) and hair in order to provide quality care. Welcome to the beginning of your transformative journey towards healthier skin (scalp) and hair. These products are: Formulated with rich, quality ingredients Have natural and beneficial properties Human tested Designed to improve quality of skin(scalp), hair and beard Formulated to help bring balance to the skin(scalp), hair, and beard Our products, are formulated with oils, butters, essential oils, rose water, witch hazel, aloe vera gel, glycerin, and real ingredients to help yield balance through the skin(scalp) and hair. Note: Wellness takes place from the inside out and from the outside in. According to Pfizer, " wellness is the act of practicing healthy habits on a daily basis to attain better physical and mental health outcomes, so instead of just surviving you're thriving." The National Library of Medicine defines wellness has "a holistic integration of physical, mental, and spiritual well-being, fueling the body, engaging the mind, and nurturing the spirit." What effect us on the inside shows up on the outside, on our skin(scalp) and hair. The skin and hair have a job to do, let's make it our mission to provide the right support. ARE YOU READY TO SUPPORT YOUR SKIN(SCALP) AND HAIR HEALTH WITH IMPACTFUL WELLNESS RESOURCES?
Heck yes!
Let's do this!
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Basic Information
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Email
example@example.com
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Are you looking for something in particular?* This field is required.
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Do you have any concerns?* This field is required.
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Which option best describes the length of the hair on your head?Trying to determine hair length can be a challenge. To help with the process, we use everyday items for compassion. Start measurement from the base of the scalp, where the hair comes out. This is a neutral question, not gender specific, in order to help determine the best scalp (skin) and hair care options.
None(Bald, like a melon)
an 1'' or less (length of a quarter of less)
2 to 4'' ( no longer than the width of a bank card
5 to 10''( 5 is a little less than the length of a soda can) 10 would be a little more than 2 cans
11'' or more (a roll of paper towels is 11'' wide)
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Is your scalp:* This field is required.At any given time, the condition of the scalp will fall under one of the following. Please chose the condition that best fits the current state of your scalp.
Oily
Dry
Normal
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What is your hair density?Density is the amount of hair you have on your scalp. It's going to be either thick, thin, of neither(average). To give you a visual, we're going to use trees as a reference. Like the trees, if you can see clear through the hair to the scalp, you have very thin density. Using the pictures, find which photo best resembles your hair density.
Very thin
Somewhat thin
Neither thin or thick
Somewhat thick
Very thick
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What is your hair's natural pattern?This is consider the natural pattern of your hair strands. Your hair will take on two different shapes when it's wet and dry. The hair's natural patten is chemical free ( no perm or relaxer), heat free ( hasn't been blow dried or flat ironed), and dry. The hair strands can have no pattern, meaning they're straight up and down like a line. The strands can have a wave pattern, similar to the patterns the water takes in the ocean. Curly hair strands go round and round, some strands are loose rounds. Some are tight (close together) rounds, which are similar to extremely curly/coily hair. It is possible to have different patterns through your scalp, always go with the pattern that is the majority.
Straight
Wavy
Curly
Extremely Curly/Coily
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What is your hair porosity?Porosity is the ability of the hair to absorb and retain moisture, which is important when rinsing hair and applying products. The hair strands has 4 main layers, some have 3. The top layer, the cuticle, protects all the other layers and the condition of this layer determines porosity. The top layer is similar to the shingles on a roof. If the hair strands feels rough, you have high porosity. For an easier, quick test of the strands, brush or comb hair, drop the strands that have shed into cup of water. Similar to the picture below of the eggs in a cup, if your strands float to the bottom, you have high porosity hair. If your strand stays floating at the top, you have low porosity. For average porosity, strands will remain in the middle of the cup.
Low
Average
High
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What is your hair texture* This field is required.Hair texture refers to the how the individual strands feel or look. It's hard to gauge by looking with the naked eye, trying gauging how the strand feels. Grab a strand or two, if your having a hard time seeing and feeling the strand, you have fine hair. If you have thick hair you can easy see and feel the hair strands in between your finger. Medium is in between, you can feel it but it's probably not sure thick. If you were to If you're are having a hard time trying to figure this out, try feeling the strands of family and friends.
Fine
Medium
Thick
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This video provides a great explanation of hair pattern, density, porosity, or texture question.Feel free to watch if you're having trouble answering https://youtu.be/pDrCZX5PTHM?si=JSC8QxsFRohPUJO_
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Is your hair currently chemically treated?* This field is required.This means you have a relaxer, perm, or color-treated hair.
Yes
No
N/A
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If yes, then which of the following?* This field is required.Please mark the answer which best describes the current state of your hair.
Color-treated
Perm (adds curl)
Relaxed (Straightens hair)
Color-treated perm
Color-treated relaxer
Other
N/A
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Are you using the products recommended for brand/s of chemical applied to your hair ?* This field is required.This means you have a relaxer, perm, or color-treated hair.
Yes
No
N/A
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Are flakes a concern?* This field is required.There are 3 main types of flakes: small tiny flakes, barely noticeable. This is a normal process of dead skin cells shedding of the scalp during the development of new cells. The next two dry and oily are a concern. Dry flakes are small and white, while oily flakes are small and yellow or grayish in color. Mark yes, for dry or oily flakes.
Yes
No
Somewhat
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If yes, which one?* This field is required.
Oily
Dry
N/A
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Do you have an extremely itchy scalp?* This field is required.
Yes
No
Somewhat
N/A
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Are you experiencing hair breakage?* This field is required.Hair in this condition will usually snap(break) from either a dry or oil state. The snap most often occurs a few inches from the scalp or towards the middle of the hair strand. Hair in this state will grow back.
Yes
No
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Are you experiencing hair loss?* This field is required.Hair loss is different from hair breakage. Hair loss normally occurs beneath the surface of the scalp. It is possible for the hair to grow back in this state, if the source (follicle, where the hair starts) has not been completely damaged.
Yes
No
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“My hair is...”* This field is required.Select ALL that apply.
Dry
Limp
Frizzy
Brittle
Damaged from heat
Thinning
Damaged at the ends (split ends)
Chemically over-processed
None of the above
Other
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How often do you wash?
Every day
Every other day
Every 3-4 days
Once a week
Every other week
Other
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How many times are you applying shampoo and rinsing?* This field is required.
Once
Twice
3 or more
N/A
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Does your scalp feel clean after shampooing?* This field is required.
Yes
No
N/A
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How long does it take to shampoo and condition your hair?* This field is required.
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How often do you apply heat?* This field is required.
Never
Once in a while
2-3 times a week
Daily
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How do you prefer to style your hair?* This field is required.
Blow-dried and styled
Air-dried and styled
Only air-dried
Only blow-dried
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Do you wear extensions or wigs?* This field is required.Extensions are described as heat infused extension, braids with weave, tape-in, sew-in, or wigs.
Yes
No
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Select all that apply* This field is required.Select ALL that apply
Heat infused extensions
Braids with weave added
Tape-in
Sew-in
Wigs
Other
N/A
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Do you have permanent locs?* This field is required.
Yes
No
N/A
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What products do you use to style your hair?* This field is required.
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Do you have any health conditions or take prescribed medication daily?
Yes
No
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Please describe health condition and medications?* This field is required.
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Does your line of work effect your scalp and hair condition?
Yes
No
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If yes, please describe the type of work, the working conditions, and how they effect your scalp and hair condition?* This field is required.
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Is this permanent or do you plan to let your hair grow back?* This field is required.Some individuals have made the choice to rock a bald head and do not have plans to grow their hair back. Some individuals made have shaved their hair because of hair loss and hair is starting to grow back. If rocking a bald head is your forever look, click PERMANENT to be redirected.
Permanent
Grow back
N/A
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Do you shave your head?* This field is required.
Yes
No
N/A
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Do you experience any of the following?* This field is required.Select ALL that apply
Dryness
Razor bumps
Redness
Irritation
Itching
Flakes
None of the above
N/A
Should be Empty: