HAIR CONSULTATION FORM

1

Name

First Name

Last Name

2

What is your main hair concern/s?

eg: Dryness, Damaged

3

What is your hair type?

Curly/Coils

Straight

Wavy

4

What is your hair density?

Thick

Thin

5

What is your scalp condition?

Dry

Oily

Sensitive

6

What is your hair condition?

Oily

Dry

Both

7

Do you suffer with Dandruff/Dermatitis?

No

A little bit - Not worried

Yes

9

What are your hair goals?

10

How much would you like to spend on Hair Care?

$150-$250

$250-$300

$300+

Other

11

Would you like to join as a VIP with a one time fee?Prices differ upon country

No ill pay full retail price

Yes ill pay the one off $32.99NZD. (Gives you access to flash sales, Your own website, A Free only for you product + more!

12

What Country do you live in?

13

Email

example@example.com

14

How would you like to be contacted?

Facebook

Instagram

15

Please provide handle name

Instagram:Kairo_Oriak22

16

If you would like to be contacted by textPlease provide your phone #

Enter phone details

17

Signature

18

Thank you for taking the time to fill out my Haircare Quiz 🥰

Once you have submitted your form hang tight and I will contact you shortly with a recommendation cart of products that best suit all your hair goals and needs :) xo