"...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
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Month
-
Day
Year
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Name
First Name
Last Name
E-mail
Phone Number
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Area Code
Phone Number
Cell Phone Carrier (For appointment reminders)
My Hair is Currently
Natural
Transitioning
Color Treated
Relaxed
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?
TWA
Chin Length
Shoulder Length
Collarbone Length
Bra Strap Length
Waist Length
What is the texture of your hair?
Fine
Medium
Course
What is your hair density (thickness)?
High
Medium
Low
What is your hair's porosity?
Normal
High
Low
Do you use shampoo?
Yes
No
How often do you wash your hair?
Daily
Every other day
Weekly
Bi-Weekly
Once a month
Other
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?
Yes
No
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?
Always
Sometimes
Rarely
Never
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?
Always
Sometimes
Rarely
never
List all leave-in conditioners you currently use
Do you moisturize your hair?
Always
Sometimes
Rarely
Never
What is your main moisturizer?
Oil
Butter
Cream/Milk
Serum
Gel
Other
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?
Rat tail comb
wide tooth comb
Regular comb
Detangling brush
Boar bristle brush
Smoothing brush
Fingers
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
Blow dryer
Hooded dryer
Heating cap
Hair steamer
Flat Iron
Curling iron/rod/wand
Crimping iron
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?
Breaking
Alopecia
Shedding
Flaking
Itchy dry scalp
Dry Hair
Product usage
Hair Care Routine
Styling
Hair growth
other
If you selected "other" above, or have additional concerns, please go into detail.
Do you exercise?
Often
Sometimes
Rarely
Never
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?
High
Low
No Stress
I have my moments
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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