Hair Consultation
Hey love!

I'm Roberta Reyes, I'm here to help guide you to those fantastic results you have been DESIRING!

We are the #1 haircare brand in North America, offering naturally based products that grow and anchor the hair. We are bringing you the best of both nature and science that together creates the first and only anti-aging, clinically tested haircare line in the world!

NO SILICONES! NO SULFATES! NO PARABENS! NO HARSH CHEMICALS! NO HARMFUL FRAGRANCES!
GLUTEN-FREE! 100% VEGAN! LEAPING BUNNY CERTIFIED! NATIONAL HAIR LOSS ASSOCIATION APPROVED!

Answer the questions below so we can get you on a hair treatment system specific to your wants and needs.

Let's get started!

Sign in to Google to save your progress. Learn more
Email *
E-mail Address *
Full Name *
Birthdate *
MM
/
DD
/
YYYY
Telephone Number *
Instagram Name
How dense is your hair? *
Thin
Thick
Is your hair... *
Is your hair color-treated? *
Is your scalp... *
Is your hair texture... *
How often do you wash your hair? *
How often do you apply heating tools? *
What products do you use to style your hair? *
What is your biggest hair concern/issue you would like to address? *
Are you interested in learning about our Rejuvinque Oil, our holy grail? *
Captionless Image
Are you interested in a detailed explanation of what products I would recommend you & how they'll fix your concerns? *
Are you interested in skincare as well?
Clear selection
Are you interested in... *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of SUNY Orange. Report Abuse
Google Forms