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Consultation Intake Form
So excited to get you going on your healthy hair/skin transformation. Please answer a few questions so that I can customize your products to your specific issues/needs.
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Email
*
Your email
Name
*
Your answer
Instagram account name
*
Your answer
Is your scalp oily/dry
*
Oily
Dry/Flakey
Normal
How would you describe the density of your hair ?
*
Very thin, parts of scalp are visible
Thin
Medium
Thick
What about the texture of your hair ?
*
Straight
Curly
Wavy
Combo - straight/wavy
How do you style your hair ?
*
Air dry
Blow dry
Heat tools (flat iron/curling iron)
Blow dry then heat tools
Required
How often do you normally wash your hair ?
*
Daily
2-4 times a week
Weekly
Is your hair color treated ?
*
Yes
No
Do you struggle with frizzy hair ?
*
Yes
No
Do you have serve damage/breakage ?
*
Yes
No
Any issues I need to know about (i.e. postpartum hair loss, alopecia, hormone imbalances(including thyroid), cancer, etc.
*
Yes
No
Are you also interested in skin care ?
*
No
Yes
Dry/Sensitive
Oily/combo
Required
Send me a copy of my responses.
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