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✨ Healthy Hair starts with a Healthy Scalp ✨
Please fill out this form & I shall get back to you with a customised hair & scalp plan ✨
18
Questions
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1
What would you like me to call you?
First Name
Last Name
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2
Email 📧
If this is how you roll!
example@example.com
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3
Drop your Digits 📞
This will only be used for me to WhatsApp/call you!
Please enter a valid phone number.
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4
How would you like me to contact you?
Please Select
Email
Whatapp
Call me
Please Select
Email
Whatapp
Call me
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5
What country do you reside in?
So I know where to send your shopping cart 😁
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6
Do you have any medical conditions?
This includes any medication you may be taking/previously taken that can cause hairloss/thinning/shedding.
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Large
Normal
Small
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quote
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Ok
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7
Are you pregnant, breastfeeding or postpartum?
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8
How thick is your hair?
Please Select
Thick
Medium
Fine
Please Select
Thick
Medium
Fine
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9
Describe your hair texture?
Please Select
Coarse
Fine
I'm not too sure
Please Select
Coarse
Fine
I'm not too sure
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10
My hair is naturally...
Please Select
Curly
Wavy
Straight
A bit of everything
Please Select
Curly
Wavy
Straight
A bit of everything
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11
How often are you washing your hair?
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12
Do you think your hair is dry?
Please Select
Yes all over
Just my scalp
Only my ends
Please Select
Yes all over
Just my scalp
Only my ends
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13
How often do you wash your hair?
Please Select
Every day
Every 2-3 days
Every 4-6 days
Once per week
Please Select
Every day
Every 2-3 days
Every 4-6 days
Once per week
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14
What issues would you like to address?
Choose up to three!
Frizz
Oiliness
Breakage/Damage
Split ends
Flaking/Itchy Scalp
Thinning/Shedding
Lack of volume
Please Select
Frizz
Oiliness
Breakage/Damage
Split ends
Flaking/Itchy Scalp
Thinning/Shedding
Lack of volume
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15
If you could fix one thing about your hair, what would it be?
Please Select
Growth/thickness
Go longer between washes
Sort my scalp
Minimise damage/split ends
Get more volume
Please Select
Growth/thickness
Go longer between washes
Sort my scalp
Minimise damage/split ends
Get more volume
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16
Lastly, what is your budget?
If I told you each product was going to last between 3-9 months (sometimes 12!!)
Please Select
£100
£130
£150
£180
I'm happy with your recommendations
Please Select
£100
£130
£150
£180
I'm happy with your recommendations
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17
File Upload
Please upload an image of your hair in natural light, including hairline/scalp if those are your areas of concern 🙏🏽
Drag and drop files here
Select files to upload
Max. file size
: 10.6MB
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18
A hearby verify that all my answers are correct and truthful..
I agree that the answers provided in this quiz are correct and truthful
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