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* 1. What is your age range?

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* 2. Please list your current hair type?

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* 3. What are your biggest issues with the current haircare market?" Please be as specific as possible.

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* 4. What is the current state of your hair?

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* 5. Are you taking any medications for the various conditions listed below or had any of the recent health occurences?

(Disclaimer: Health Data will be protected according to HIPPA laws. Why we ask? Some medications can have a direct affect on key nutrients in your body, pulling them away from sources like hair, skin, and nails. While we don't completely promise to reverse this will topical solutions, knowing this information helps us share insights that may be best for you as well as evaluate personalized product suggestions).

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* 6. Select your #1 hair challenge 

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* 7. When you hear the words "personalized haircare" what do you think of? (Ex. Products, Experience, Customer Service)

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* 8. Select Your #1 Hair Goal

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* 9. Do you currently use any of these products? If not, please submit which products you use in the text box.

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* 10. Please enter your email for a chance to win a complete Florae Hair Wellness Collection!

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