• Botanical Scalp Health Assessment

    Healthy hair begins with a balanced scalp. Our botanical scalp treatments take a holistic approach, considering scalp condition, lifestyle, environmental exposure and daily habits. This assessment allows us to thoughtfully select your OWAY treatment protocol and provide individualized recommendations for maintaining scalp wellness beyond your appointment.
  • Format: (000) 000-0000.

  • 01 | Scalp Health History

  • What concerns are you currently experiencing? Select all that apply.*
  • How long have you experienced these concerns recently? (less than 30 days)*
  • Have you been diagnosed with any scalp or skin conditions? Select all that apply*
  • Are your symptoms persistent or do they fluctuate?*
  • Have you consulted a dermatologist or healthcare professional regarding your scalp?*

  • 02 | Lifestyle + Internal Factors

  • Have you experienced any significant changes within the last 6–12 months?*
  • How would you describe your current stress levels?*
  • How would you describe your daily hydration?*

  • 03 | At-Home Scalp Care + Remedies

  • How frequently do you cleanse your scalp?*
  • Which of the following do you currently use?*
  • Are you currently using any prescription or over-the-counter scalp treatments?*
  • What is your primary goal for your scalp health? Select all that apply.*

  • 04 | Contraindications + Sensitivities

  • Do you have any known allergies or sensitivities?*
  • Have you experienced any of the following recently?*

  • 05 | Physical Comfort + Sensory Preferences

  • Please identify any areas where you do not consent to touch or massage.*
  • Preferred massage pressure*
  • Preferred treatment tone*

  • 06 | Treatment Goals + Continuing Care

  • Are you interested in developing a personalized at-home scalp care routine?*
  • Are you open to periodic scalp treatments as part of your ongoing wellness routine?*

  • Informed Consent

  • I understand that ASHWHAIR's Botanical Scalp Spa provides non-medical, cosmetic scalp wellness services utilizing OWAY botanical products.

    I acknowledge that these services are designed to support scalp cleanliness, comfort, and general wellness, and are not a substitute for medical evaluation or treatment.

    I confirm that the information provided is accurate to the best of my knowledge and understand that treatment protocols may be modified or deferred based on scalp condition, sensitivities, or contraindications.

    I understand that I may withdraw consent or request changes to my treatment at any time.

  • Date
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    2 digit month, 2 digit day, 4 digit year
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