Jane B. Natural Beauty

"...Your Beauty is my Passion!"
Tell us all about your hair!

This will help us in providing you with the best possible hair care!
Today's date

MonthDayYear
Name

First NameLast Name
E-mail
Phone Number

Area CodePhone Number
Cell Phone Carrier (For appointment reminders)
My Hair is Currently

Other
If natural, how long have your been natural?
If transitioning, approximately, how much new growth do you have?
If relaxed, when was your last touch up?
If relaxed, do you plan to go natural?
What is your current hair length?
What is the texture of your hair?
What is your hair density (thickness)?
What is your hair's porosity?
Do you use shampoo?
How often do you wash your hair?
Describe you wash routine
List all of the shampoos that you currently use
If you do not use shampoo, please list all products you use to cleanse your scalp and hair
Do you Co-wash?
List all conditioners that you currently use
Include those you use to co-wash, Do not include deep or leave-in conditioners.
Describe your conditioning routine
Do you deep condition?
List all deep conditioners you currently use
Describe your deep conditioning routine
Please be as detailed as possible. Do not include leave-in conditioners
Do you use leave-in conditioner?
List all leave-in conditioners you currently use
Do you moisturize your hair?
What is your main moisturizer?
List all moisturizers you currently use
Describe your moisture routine
List any other products you use in your hair, store bought or homemade
What tool (s) do you use in your hair?
How much time do you dedicate to your hair routine?
Do you use heat of any kind?
If yes, what forms of heat do you use in your hair
Do you color your hair? If so, when was the last time?
Do you wear hair extensions? If so, which and how often?
Do you wear wigs? If so, how often?
Do you wear protective styles? If so, which ones and how often?
What are your hair concerns?
If you selected "other" above, or have additional concerns, please go into detail.
Do you exercise?

Other
Do you have health conditions or on any medication that may affect our hair growth?
The next two questions are optional. How would you describe your stress level?
Have you ever had hair loss due to stress? If so, how long ago?
What are your short-term goals for your hair? (up to 1 year)
what are your long-term goals? (1 year and beyond)
what are your preferred styles?
Upload the most recent pictures of your hair of your hair
Upload pictures of your style wish list
Please feel free to provide us with any additional information about your hair.
How did you find Jane B. Natural Beauty?
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Tell us all about your hair!