YOUR HAIR TEST

Take the HairTest!

Last name: ** First name: **

Address: City: **

State: ** Postal zipcode: ** Country: **

Phone: Fax:

E-mail: *

ATTENTION: You must fill the required information above, before you proceed to the Hair Test!

TEST FORM

Please fill out this form carefully, then the final results will be accurate.

MY NATURAL HAIR IS	CHEMICALS ETC. USED IN MY HAIR ARE	DAMAGES IN MY HAIR ARE
Texture	Body wave	Dry
Look	Perm [curly]	Very dry
Limp	Color rinse	Brittle
Unmanageable	Color non peroxide	Tangling
Sparse	Permanent color [tint]	Split ends
Cowlick	High lights	Porous
Oily	Frostings	Breaking
Flat	Bleach	Crumbling
Lifeless	Straightening [relaxed]	Over processed
Coarse	Shampoo	Damaged by sun
Heavy	Conditioner	Frizzy
Bunched	Medication	Heat etc.
Stubborn	Extensions	No shine
	Wig	Else [ describe below]
How many years have you used conditioners?	Toupee

I consider the biggest problem[s] with my hair is[are]:

REMEMBER:

You will be given a score (between 0 and 10), exact figure, in these three categories.

1. The health of your hair at present time

2. The state of your natural hair

3. The overall picture

You will also receive a "prescription" of how, your hair with all its existing problems,natural or otherwise, can be completely free of problems and as beautiful as you have always dreamed and wanted it to be!

I have carefully filled the Test Form above and I'm ready to

I forgot something and want to add it.

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YOUR HAIR TEST

TEST FORM

MY NATURAL HAIR IS

CHEMICALS ETC. USED IN MY HAIR ARE

DAMAGES IN MY HAIR ARE

You will also receive a "prescription" of how, your hair with all its existing problems,natural or otherwise, can be completely free of problems and as beautiful as you have always dreamed and wanted it to be!

To safe & secure RJ NetShop