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13
Questions
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1
Name
First Name
Last Name
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2
Email
example@example.com
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3
Phone Number
Please enter a valid phone number.
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4
Country of Residence
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5
Which best describes your scalp?
Select all that apply
Dry
Oily
Normal
Itchy/flaky
Scalp Psoriasis
Sensitive
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6
Which best describes your hair texture
(how thick each strand is)
Thin/Fine
Medium
Not sure
Coarse
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7
Which best describes your hair density
(the amount of hair on your head)
Thin
Dense
Medium
Not sure
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8
Which best describes your hair
Select all that apply
Damage
Dry/Brittle
Oily
Frizzy
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9
Which best describes your hair
Select all that apply
Curly
Kinky
Straigth
Short
Long
Shoulder Length
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10
How often do you wash your hair
Everyday
Every other day
Twice a month
Type option 4
Other
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11
Do you have any hair loss
Thinning
Bald spots
Severe balding
Postpartum hair loss
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12
What is your main hair concern and your main hair goal?
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13
If you're feel comfortable , Please Send a Photo of your hair
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