Form
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Instagram or Facebook handle
*
Where are you located? city/state/country
WHO REFERRED YOU or HOW did you find me?
Let’s talk about your head. Check ALL that apply.
oily hair/scalp
dry/flaky scalp
dry ends
sensitive/irritated scalp
normal scalp
thinning/hairloss
curly/wavy hair
I like to wear my curls staright
I wear my natural curls
frizzy
thick hair
thin/fine hair
I can never get enough volume
I color treat my hair
damage from bleach
I have extensions
I only air dry my hair
I air dry & use heat
I use heat everytime I style
I have split ends
I can’t live without dry shampoo
I love purple shampoo
Are you currently satisfied with your skin?
yes
no
could be better
Are you experiencing any of these common skin issues? Check all that apply
Acne
Oily skin
Dry Skin
Combo
Normal
Fine lines/wrinkles
Dark spots/Age spots
Dull skin/lacking glow
Definitely interested in skincare makeup
not interested
Are you familiar with ingredients in beauty products and how these things can affect your overall health?
I’m familiar but don’t really care
I’m somewhat familiar but interested in more information
I’m an avid label reader and all about the low tox lifestyle
I’m not familiar with how ingredients affect my health
I like to be aware and make smart decisions if it meets me beauty needs
How would you like me to get in touch with with me regarding product recommendations
*
TEXT ME
Send me a dm on Instagram or Facebook
What is your price range for new hair care or skincare regimen? Our VIPs save 15% plus on every order
*
On a budget & want it as low as possible
$100-$150
Whatever it takes to get me the results I’m after
I prefer to buy a bulk pack of everything $ get the biggest discount
Are you interested in the business side at all? (must be 18+)
No, just want to be a customer
If I love the products I am open to the option
YES!
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