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Hair Consultation Form
Our hair consultants will get back to you soon !
What is your current hair length?
*
Short
Medium
Shoulder length
Long
How would you describe your scalp?
*
Dry
Normal
Oily
Scalp Issues
How would you describe the current condition of your hair?
*
Healthy
Slightly damaged
Severely damaged
Shampoo frequency :
Select
Weekly
Bi-weekly
As needed
How would you describe the natural texture of your hair?
*
Straight
Wavy
Curly
How would you describe the density of your hair?
*
Fine
Medium
Thick
Super thick
Are you currently taking any medication that has side effects that can cause hair thinning and/or hair loss?
*
Yes
No
Which one :
*
Breaking
Shedding
Flaking
Itching
None
Do you have now, or have had in the past, any problems with hair loss?
*
Yes
No
Do you have problem with dandruff?
*
Yes
No
Would you like to send a current [close-up] picture of your hair?
*
Yes
No
Select Service/Treatment
Select
Shampoo
Conditioning
Setting
Blow dry
Cutting
Colouring
Relaxing
Hair up
Extensions
Others
*
I understand that the above information will be kept confidential and is accurate to the best of my knowledge.
Your Company Name
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Linkedin
Google+
A brief intro is always great. It's Helps people to identify your company.
Address
[email protected]
800-555-0101
yoursite.com