YOUR HAIR TEST

Take the HairTest. Your personal information is safe and secure!

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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