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* 1. Email address

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* 2. What is your name?

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* 3. What is the texture of your hair?

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* 4. What is your hair type?

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* 5. How dense is your hair?

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* 6. What are your main concerns with your hair?

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* 7. How often do you wash your hair?

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* 8. Do you have breakage or split ends?

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* 9. What would you like to improve about your hair?

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* 10. Preferred Method of Contact (please list two)

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