Scalp & Soul Starter guide

1

Hi, Whats your name?* This field is required.

First Name

Last Name

2

Great to meet you, {hiWhats:first}! What age range best describes you?* This field is required.

Im in my early 20's

Im in my late 20's early 30's

Mid 30's early 40's

Mid 40's to 50's

55 and wiser ✨

3

Thanks {hiWhats:first}! Now tell me --Which of these sound most like your hair concern?* This field is required.

My hair feels dry and brittle.

Im starting to see breakage in parts of my hair.

Im experiencing slow Growth/ Stunted Growth.

I have bald spots or my edges are thinning.

I struggle with severe dandruff or buildup on my scalp.

My hair is thinning or shedding more than usual.

My hair feels damages from chemicals or color.

My scalp feels sore or tender.

4

How long have you noticed this happening?* This field is required.

It started within the past year.

It's been going on for a year or two now.

Ive been dealing with this for 3-4 years.

It's been 5 years or longer.

5

Which of these feel most true to you?* This field is required.

I can't wear styles that I want anymore.

I don't feel as confident as I used to.

Im starting to feel depressed about my hair.

I avoid social events or photos because of my hair.

6

How stressed do you feel on a regular basis?* This field is required.

High

Moderate

Low

7

Do you also deal with any of these health or skin conditons that might affect your scalp?* This field is required.

Asthma

Eczema

Allergies

Rosacea

Thyroid Issue

Other

8

Have you tried anything so far to improve your hair and scalp ?* This field is required.

Yes, Ive tried some treatments/products.

No, I haven't tried anything yet.

9

Thanks {hiWhats:first}! Ive put together your Healthy Hair and Scalp Starter Guide -- Where should I send it?* This field is required.No Spam, just your starter guide from a licensed hair loss practitioner! -Promise.

example@example.com