Hair Consultation Form

Name

First

Last

Order Number

What's your gender?

Male
Female
Other

Your Age

What is your ethnicity?

In what climate do you live?

What's your hair type?

Dry
Normal
Greasy or Oily
Oily Roots with Dry Ends

What is your hair pattern?

Straight
Wavy
Curly
Coily

How thick are your hair strands?

Have you chemically altered your hair?

What kind of day time styling do you do?

What kind of nighttime styling do you do?

What are your hair consider?

If you are a woman, do you suffer from menopause?

Yes
No

Do you have any kind of pus?

Yes
No

Do you have any kind of tooth and/or gum disease?

Yes
No

Do you suffer from trauma or bad emotions?

Yes
No

How do you feel about your hair's condition?

Tell me about your hair care routine

Have you been pregnant in the last 6 months?

Are you pregnant Now? (Women)

Yes
No

Is your scalp sensitive?

Yes
No

Have you ever suffered from allergies?

Yes
No

Do you currently color your hair?

Yes
No

If yes, how often do you color your hair?

Do you now suffer from dandruff?

Yes
No

Do you now suffer from itchy scalp?

Yes
No

Do you suffer from a bad smell in your hair or scalp?

Yes
No

Do you usually pull your hair back?

Yes
No

Have you used hair extensions before?

Yes
No

If yes, which method have you fitted?

Are you currently taking any medicines?

Yes
No

If yes, please list all the medicines you are taking.

Do your parents have baldness or thinning hair?

Yes
No
Both

Would you like to add length, volume (thickness), or both?

Length
Volume (thickness)
Both

Please mention any health, hair, or scalp issues

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