HairFinity Healthy Hair Consultation

The purpose of the Healthy Hair Consultation is to provide a personalized recommendation for your individual hair problems, issues, and goals. After you submit this form, one of our consultants will address your specific concerns. While we try to answer all consultations within 1 hour, it may take up to 24 hours to view your results. If you have already submitted a consultation, you may login to view your results here. Only one submission per individual is allowed in a 30 day period.

Full Name:
Email Address:
Repeat Email Address:
Address
City
State
Zip Code
Please indicate your hair type:	African American (Ethnic) Caucasian Asian Other
Please indicate any of the following services you have had in the last year:	Chemical Relaxer Sodium Hydroxide Permanet Wave Guanidine Hydroxide Permanent Semi-Permanent Higlights / Bleach
Please indicate if you have had any of the following hair/scalp problems im the last year:	Breakage Shedding Dryness Thinning Dandruff Scalp Itch Ringworm/Fungus Balding Slow Growth
Check the ingredients of the shampoos you use and indicate if they contain any of the following:	Ammonium Laureth Sulfate Ammonium Lauryl Sulfate TEA Laureth Sulfate TEA Lauryl Sulfate Sodium Lauryl Sulfate
Do you heat style your hair?	Yes No
Please indicate the conditioners/treatments you use often:
Please indicate any of the following that you do regularly:	Exercise Drink Water Take Vitamins Smoke Drink Alcoholic Beverages
Please indicate any other issues or concerns:

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