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First and last name*
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Address
Apartment, suite or unit number
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How long is your hair?*
Short
Medium
Long
What is your hair texture?*
Straight
Curly
Wavy
How often do you wash your hair?*
What is the current condition of your hair?*
Thin and Fine
Split Ends
Heat Damage
Dry and Frizzy
Dandruff
Regrow, Growing Out
Healthy and Shiny
Oily
Thick and Voluminous
Curly and Bouncy
Color-Treated
Straight and Smooth
Short and Stylish
In Need of a Cut
Natural and Untreated: My hair is in its natural state – I haven’t colored or chemically treated it
Experiencing Hair Loss
Braided
Wavy and Textured
Have you use the following in your hair before?*
Permanent Hair Color (salon)
Box Dye
Keratin Treatment
Relaxer
Henna
Perm
None
When did you last apply professional or unprofessional color in your hair?*
Kindly list the hair products that you are using*
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Do you take medication?*
Yes, I take medication daily for a chronic condition
Yes, but only as needed for specific health issues
Yes, I'm currently on a course of antibiotics/other specific medication for a temporary health prob
Yes, I take supplements or vitamins for general health maintenance
No, I don't take any medication regularly
No, I prefer to manage my health through alternative methods like diet and exercise
No, but I used to take medication in the past for a specific condition
Not currently, but I have in the past for mental health reasons.
I'm considering medication but haven't started yet
Yes, I take medication for a combination of physical and mental health conditions
Yes, I take medication for chronic pain management.