Dynamic Consultation Form Facescapes

First Name

Last Name

Email

example@example.com

New Guest or Existing Guest

NewExisting

What are you skin concerns?

Check all that apply: These can factor in hormonal changes, eating habits and hair growth cycles. Supplements may affect hair texture

are you pregnant?are you taking birth control?Hormone Therapieshormonal abnormalities

Check all that apply: These can cause limitations to the service. How are they treating conditions and what specific triggers (heat, humidity or chemical sensitivities. If there is a flare the guest may be more likely to be sensitive.

do you have acne?do you have exzema?do you have psoriasis?do you have dermatitis?

Check all that apply: Determines the timing for the service. Dry scalp needs conditioning treatments with moisture. IF scalp is then lengthen the massage to break down and remove buildup on the scalp. If oily, process CGXL under heat longer to remove buildup.

do you have dry, itchy, oily or flaky scalp?

Check all that apply: this is for environmental or chemical stressors on the scalp.

How much stress?High or low blood pressure?Do you engage in outdoor activities?Do you smoke? or second hand smoke?

How often do you wash?

how often do you wash

What time of day do you wash your hair?

just before bed, when you rise?

What does your haircare routine look like?

What products do you use currently?

Any surgeries?

medications and supplements including topical

What kind of water do you have at home?

any adverse reaction to a cosmetic?

How many shampoos per week?

Which products do you use?

What do you want to gain from this?

Before Photo

After Photo

Personal Notes from Consultation:

What I did:

Dynamic Scalp Consultation Form