F R E E B E A U T Y F O R M
Hey friend! I’m Mia 💁🏻♀️
If you’ve been struggling with your hair or skin — oily roots, dry scalp, breakage, slow growth, or combo skin that just won’t balance, I get it. I’ve been there too. I used to manage a salon and thought I had the “best of the best” products, but I still battled a tricky scalp and skin that kept me hiding behind makeup and filters. Then I found MONAT. I started with skincare, fell in love with how confident I felt bare-faced, and later discovered the haircare I didn’t even know I needed. Now I get to help women like you feel good in their own hair and skin with clean, plant-based beauty products that actually work. Every recommendation is personalized for you — no one-size-fits-all. MONAT is anti-aging, cruelty-free, Leaping Bunny certified, made in the USA, and formulated to European safety standards (which are even stricter than the US). The products are highly concentrated and powered by a unique blend of essential oils that nourish from the inside out. Fill out my form and let’s get you glowing from root to tip ✨
Name
*
First Name
Last Name
Email
*
example@example.com
IG handle
Where are you located? City/State/Country
WHO referred you or HOW did you find me?
Phone Number
*
-
Area Code
Phone Number
Let's talk about your head. Check all that apply.
oily scalp/hair
dry/flaky scalp
normal scalp
thinning/hair loss
curly/wavy hair
wear my curls straight
wear my natural curls
frizzy
thick hair
thin/fine hair
can't ever get enough volume
color treat my hair
damage from bleach
extensions
air dry
hot tools
split ends
can't live without dry shampoo
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
signs of aging
fine lines/wrinkles
dark spots/age spots
dull skin/lacking glow
interested in skincare makeup
Are you familiar with ingredients in beauty products and how these things can affect your overall health?
familiar but don’t really care
somewhat familiar but could use some more info
an avid label reader and all about that low-tox life
not familiar with how ingredients affect my overall health
How would you like me to get in touch with you with my product recommendations?
*
text me
send me an IG DM
What is your price range for a new haircare or skincare regimen? Our VIPS save 15%+ off every order
*
definitely on a budget & want it as low as possible
$100-$150
whatever it takes to get help!
prefer to buy a bulk pack of everything & get the biggest discount
Are you open to the business side at all? (must be 18+)
no, I just want to be a customer.
maybe, if I love the products I'm open to it
yes!
(OPTIONAL) ADD A PICTURE OF YOU / YOUR HAIR
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