WELCOME
👋 Hi, I'm Shaina. I'm a Hair Extension Specialist, Associate Trichologist, and Hair & Scalp Care Educator. I work with women (and men) who want healthier hair, a supported scalp, and a routine that actually makes sense for their life. If you found your way here, you're probably wanting to improve something about your hair or scalp. You're in the right place. This questionnaire helps me understand your hair history, current concerns, scalp health, and goals so I can build a personalized regimen for you. Every routine I create is based on your hair type, lifestyle, and what your scalp actually needs... so you're not stuck guessing or product hopping anymore.Your regimen is included with your product purchase, and you'll have me as your personal guide to walk you through it.The products I recommend are vegan and cruelty-free, gluten-free, free from sulfates, parabens, and non-soluble silicones, and formulated with scalp-respecting cleansing systems. Clean ingredients, consistent quality.What makes this different is the support. You're not just getting product recommendations. You're getting education, guidance, and a long-term plan so your hair and scalp can actually improve over time.Please leave your correct Instagram handle and phone number so I can send your personalized routine and follow up with you. You can expect your response within 3–6 business days. If you're just looking for general tips, I share free education on Instagram (@ShainaAmyCampbell).I'm here to help you feel good about your hair again.
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FILL OUT FORM
Name
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First Name
Last Name
Phone Number
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Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Instagram or Facebook handle
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Where are you located? City/State/Country
*
When is your birthday?
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 -
Month
 -
Day
Year
Date
WHO REFERRED YOU or HOW did you find me?
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Let's talk about your hair and scalp. Check all that apply.
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oily hair/scalp
dry/flaky scalp
sensitive / irritated scalp
normal scalp
thinning/hair loss
curly/wavy hair
I like to wear my curls straight
I wear my natural curls
frizzy
thick hair
thin/fine hair
can't ever get enough volume
I color treat my hair
damage from bleach
extensions
I only ever air dry
I air dry & use heat sometimes
I use ALL THE HEAT
I have split ends
I can't live without dry shampoo
I love purple shampoo
Wavy/curly hair only: What is your curl type?
2a
2b
2c
3a
3b
3c
4a
4b
4c
Are you familiar with ingredients in beauty products and how these things can affect your overall health?
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I’m familiar but don’t really care
I’m somewhat familiar but could use some more info
I’m an avid label reader and all about that low-tox life
I’m 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 (make sure you put your number!
Send me an IG DM (make sure you listed your @ handle)
EMAIL ME
What is your price range for a new haircare regimen? Our VIPS save 15%+ off every order
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I'm definitely on a budget & want it as low as possible
$100-$150
Whatever it takes to get help!
I prefer to buy a bulk pack of everything & get the biggest discount
Are you open to the Business side at all? (must be 18+)
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No, I just want to be a customer.
Maybe, if I love the products I'm open to it
Yes!
Are there any other concerns or sensitivities/allergies you'd like to share with me?
(OPTIONAL) ADD A PICTURE OF YOU / YOUR HAIR
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