VESTILLS Hair & Scalp Assessment
This assessment helps us determine whether you’re hearing needs moisture recovery, breakage repair, or scalp for treatment
Start Your Personalized Hair Recovery Plan
This guided assessment helps identify what may be contributing to your hair or scalp concerns so VESTILLS can recommend the best next step.
Take your time and answer honestly. Your responses help us understand your hair story, your scalp needs, and the most supportive path forward — whether that points to moisture support, breakage repair, scalp care, or a hair loss recovery plan.
Client Information
Full Name
*
First Name
Middle Name
Last Name
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Date
*
-
Month
-
Day
Year
Date
Current Hair Concerns
Main hair concerns
*
Dryness
Breakage
Shedding
Split Ends
Lack of Growth
Frizz
Dullness
Tangling/Matting
Itchy Scalp
Other
Your answers are helping identify whether you may need moisture support, breakage repair, scalp care, or a hair loss recovery plan — so we can guide you toward the most supportive next step.
How long have you been experiencing these concerns?
*
What have you tried to address these concerns, and what were the results?
Current Product Usage
Share your current routine so we can identify whether a Moisture Recovery Plan, Breakage Repair Plan, Hair Loss Recovery Plan, or Porosity-Based Product System may be the best fit.
Current shampoo (brand if possible)
Current conditioner (brand if possible)
Current leave-in conditioner
Oils or serums used
Styling products used
How often do you wash your hair?
Please Select
1x/week
2x/week
Bi-weekly
Monthly
Other
Do you use heat on your hair?
Yes
No
If yes, how often do you use heat?
Do you sleep with your hair protected using a bonnet or scarf?
Yes
No
Hair Loss Assessment
Hair loss screening helps identify patterns and possible triggers so we can point you toward the most supportive care path.
Are you experiencing hair loss?
*
Yes
No
Where is it noticed?
Edges
Crown
Nape
All Over
Other
Type of hair loss noticed
Shedding (excess hair falling out)
Thinning (less density over time)
Bald spots
When did this begin?
Possible triggers
Stress
Hormonal Changes
Medical Condition
Tight Styles
Chemical Damage
Postpartum
Unknown
Are you currently under medical care for this?
Yes
No
Hair Porosity, Density & Texture
Porosity Test Result
*
Please Select
Low Porosity (repels water/products sit on hair)
Medium Porosity (balanced moisture retention)
High Porosity (absorbs quickly, loses moisture fast)
Hair Density
*
Please Select
Low Density (scalp easily visible)
Medium Density
High Density (full/thick hair)
Hair Texture
*
Straight
Wavy
Curly
Coily
Expected Hair Direction / Client Goals
Desired outcome
*
Hair Growth
Thickness
Length Retention
Moisture Balance
Healthy Scalp
Style Maintenance
Damage Repair
Preferred styling direction
*
Silk Press
Natural Styles
Protective Styles
Low Manipulation
Unsure (Needs Guidance)
What does healthy hair look like to you?
*
Are you willing to follow a recommended hair care plan?
*
Yes
No
Professional Recommendation / Internal Notes
Stylist / Clinic Use Only — use this space to map the client to the most appropriate plan and recommendation path.
Scalp Condition
*
Please Select
Healthy
Dry
Oily
Sensitive
Flaky
Inflamed
Other
Follicle Status
*
Please Select
Intact
Miniaturizing
Dormant
Blocked
Not Assessed
Other
Recommended Treatment Plan
*
Product System Assigned
*
Please Select
Hydration Support
Scalp Clarifying
Strengthening Care
Growth Support
Repair & Restore
Custom Program
Estimated Timeline (6–12 months)
Your Hair Plan Preview
VESTILLS will review your responses and place you into the best-fit path for your needs — whether that looks like a Moisture Recovery Plan, Breakage Repair Plan, Hair Loss Recovery Plan, or Porosity-Based Product System.
This preview helps us understand whether your best next step may be a Moisture Recovery Plan, Breakage Repair Plan, Hair Loss Recovery Plan, or a Porosity-Based Product System. Your answers guide us toward the most supportive path for your hair and scalp goals.
What kind of help are you looking for right now?
*
A personalized consultation
Product recommendations for my hair type
A full hair restoration plan
I’m not sure yet, I need guidance
How soon are you looking to get started?
*
As soon as possible
Within 2 weeks
Within 30 days
Just exploring for now
Choose Your Next Step
This is the moment to move forward with a clear plan — pick the option that feels right for you and we’ll guide you from there.
After you submit, VESTILLS will use your answers to shape a personalized hair plan and recommend the most helpful next move. Healthy hair starts with the right diagnosis and consistency — and this is your first step toward that plan.
What would you like to do after submitting this form?
*
Book my consultation now
Send me product recommendations first
Have someone contact me
Client Commitment Agreement
Client Signature
*
Date
*
-
Month
-
Day
Year
Date
Complete Consultation
Complete Consultation
Should be Empty: