Welcome

1

Name

First Name

Last Name

2

Phone Number

Please enter a valid phone number.

3

Email

example@example.com

4

What’s the best way to contact you?

7

How would you describe the condition of your hair strands?

Dry and brittle

Healthy

Split ends

Won’t grow past a certain length

8

Describe your hair type…

Straight

Curly

Wavy

Coily

9

How do you typically style your hair?

Hot tools (blow dryer, curling iron, flat iron)

Air dry WITHOUT products

Air dry WITH products

Diffuse curly hair

Protective styles

10

Do you have hard water?

YESNO

11

Do any of these apply to you?

My hairline is thinning

I’m having a hard time controlling frizz

My scalp needs help!

My hair is damaged from coloring it too much heat

My hair styles don’t last

My hair is flat and dull

None of these. My hair is great but I prefer non-toxic products.

12

What’s your biggest hair goal?for example (grow it out, repair damage, increase density, heal curls…)

13

Any questions/concerns/medical conditions you would like to share with me?