FOR HEALTHY HAIR AND SKIN

1
Full Name* This field is required.
First Name
Last Name
2
Phone Number* This field is required.
Area Code
Phone Number
3
E-mail
4
Instagram handle?* This field is required.
5
Birthday* This field is required.
6
Gender
Male
Female
7
What is your hair density?* This field is required.
Thin/fine
Thick
Coarse
Medium
8
What is your hair type
Straight
Wavy
Curly
Coiled/Kinky
9
What is your hair texture?* This field is required.
Dry
Frizzy
Both
Neither
10
Do you have colored hair?
No
Yes: Blonde
Yes: Platinum
Yes: Brunette
Yes: Other
11
What is your current hair length?
Short
Medium
Long
Very long
12
Is your scalp:* This field is required.
Oily
Dry
Normal
13
Is dandruff an issue?* This field is required.
Yes
No
Sometimes
14
How often do you wash your hair?
Daily
Every 1-2 days
Every 3+ days
15
How often do you use heat tools on your hair?
16
How do you dry your hair?
Air dry
Blow dry
17
What are the primary hair concerns that you'd like to address? *Select up to 3** This field is required.
Dryness
Lack of shine
Restore body and bounce to hair
Control frizziness
Need fullness for fine hair
Hair loss/thinning
Tone down brassiness
Repair damaged hair from over-processing
Oily scalp
Dandruff/flakiness
18
What are your secondary hair concerns that you'd like to address?
Dryness
Lack of shine
Restoring body and bounce
Control friziness
Need fullness for fine hair
Hair loss/thinning
Tone down brassiness
Repair damage from over processing
Oily scalp
Dandruff/flakiness
19
Whats your skin type?
Dry
Oily
Combination
Sensitive
20
Skin conditions:
Eczema
Psoriasis
Neither
Type option 4
21
Do you have:
Acne
Age spots
Fine lines/wrinkles
Sun spots
Large pores
Bags/Dark under eyes
22
What is your biggest skin concerns/issues
23
What is your current skin care routine?
24
MONAT WellnessWhich wellness solutions are you interested in incorporating into your daily routine? (Check all that apply)
Cleansing support
Immune support
Energy Support
Skin, Hair and Nail health
Gut health
Focus and Productivity
Healthy aging
Positive mood
25
Are you interested in a detailed explanation of what products we would use for your hair, skin or wellness concerns and how can we fix them?
Yes, text me!
Yes, DM me!
26
I'm interested in:
Transforming my hair
Transforming my skin
Monat Wellness
Working the business
All of the above
Should be Empty: