Health and Wellness Assessment

Name*

First NameLast Name

Email

example@example.com

What is your primary health concern? (Select all that apply)*

Do you have any diagnosed conditions or specific health issues I should be aware of? *

Are you taking any medications or supplements? (This helps avoid potential interactions.)*

What is your typical daily diet like?*

balancedprocessed foodsvegetarian, etc.Other

How often do you exercise, and what type of activities do you do?

Do you have any known allergies or food sensitivities?*

glutendairy, etc.Other

How would you describe your stress levels ?*

LowModerateHighOther

How is your sleep quality, and how many hours do you usually sleep per night?*

Do you experience hormonal imbalances or symptoms like irregular periods, mood swings, or fatigue?

Do you have any specific health goals?

better energyimproved digestionrelaxationOther

Please feel free to add anything that you would like for us to know for your personal product.

I certify that all information provided is accurate and true to best of my knowledge.

**Product Disclaimer for Hair and Skin Care Products**

The use of Suhaylah Nyle hair care and skin care products is subject to the following terms and conditions:

1. General Information
- Our products are formulated using high-quality ingredients and are designed for external use only.
- Individual results may vary depending on skin or hair type, underlying conditions, and other personal factors.

2. Allergies and Sensitivities
- Please review the ingredient list on the product packaging before use to identify potential allergens.
- Perform a patch test on a small area of skin 24 hours before full use. If irritation, redness, or discomfort occurs, discontinue use immediately and consult a healthcare professional.

3. Medical Concerns
- These products are not intended to diagnose, treat, cure, or prevent any disease.
- If you are pregnant, nursing, or under the care of a physician for a chronic condition, consult your doctor before use.

4. Storage and Handling
- Keep products away from direct sunlight, heat, and humidity to maintain quality.
- Keep out of reach of children and pets.

5. Liability
- Suhaylah Nyle is not responsible for adverse reactions due to improper use, storage, or failure to follow instructions.
- By using these products, you agree that Suhaylah Nyle is not liable for any damages arising from their use beyond the purchase price.

6. Professional Advice
- For professional guidance on specific skin or hair concerns, consult a licensed dermatologist or trichologist.

By purchasing and using Suhaylah Nyle products, you acknowledge that you have read, understood, and agree to this disclaimer.

Health and Wellness Assessment Form