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* 1. What is your First & Last name?

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* 2. What is your Email address or Cell phone number that’s best to follow up with?

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* 3. What products are you currently using?

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* 4. What do you like or dislike about the products your using now?

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* 5. How often do you wash your hair?

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* 6. Do you use hot tools & styling products?

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* 7. Hair texture?

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* 8. Hair type? (Check all that apply)

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* 9. Describe any other hair/scalp concerns

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* 10. I would like to (check any that apply)...

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