DM Steps University

Natural Hair Solutions | Advance Training / Trichology | Continued Education I CEU             Certification Advance Degree Programs

DM Steps University

Natural Hair Solutions | Advance Training / Trichology | Continued Education I CEU             Certification Advance Degree Programs

What you need to know about your

Hair Consultation Form

This information will help us prepare for your Personal Hair Consultation.

Name First _____________ Last _____________ Phone Number (        ) _ _ _ -  _ _ _ _

Email: 

Street Address ____________________ City _______________ State _________ / Zip Code ________ Country _____

 

HAIR PATTERN & TEXTURE What is your dominate curl pattern? Check the one that best suites you.

Curly_______ Very Curly _______ Coily _______Tight Coils _______ Zig-Zag Coils _______ Curly/Kinky _____

 

What is the width of hair strand?

Fine _____ Medium _____Thick _____ Thick & Course _____

 

What is your hairs porosity level?

Low _____ Medium _____ High _____

 

HAIR CARE REGIMEN

Do you have any of these chemical processess done regulary?

Texturizer Relaxed Color Treated _____

 

What hair styles have you worn in the last 12 months?

Wash-n-Go ______ Strand Twist Puffs _______ Afro Weave _______ Wig Crochet Style ______Micro Braids _____ Extensions _____ Flat Ironed _____ Big Chop _____

 

How often do you cleanse/co-wash your hair?

Daily 2x a Week _____

Once a Week _____

Every 2 Weeks _____

Monthly _____

Other _____

 

How often do you deep condition your hair?

Once a Week _____

Every 2 Weeks _____

Monthly _____

Quarterly _____

Other _____

 

How often do you trim or cut your hair?

Monthly _____

Quartely _____

Every 6 Months _____

Annually _____

Other _____

What are your current hair goals and what do you need to modify to achieve your goals?

HAIR CONDITION Please check each on that applies, if not sure, leave unchecked.

 

Is your hair frequently dry and brittle? Yes __ No __

Do you dampen your hair daily? Yes__ No__ Does your hair have very little elasticity? Yes __ No ___

Do you live in an area where there is hard water? Yes___ No___

Do you have dandruff? Yes___ No___

Do you have an itchy or dry scalp? Yes___ No___

Do you have thinning or hair loss around the hair line? Yes___ No___ If yes please explain? ________________________________________________________________________________________________________________________________________________________________________________________________Do you have heat damage? Yes___ No ___ If yes please explain? ________________________________________________________________________________________________________________________________________________________________________________________________Does your hair frequently have knots & tangling? Yes___ No___ If yes please explain?________________________________________________________________________________________________________________________________________________________________________________________________ What would you like to learn from the Hair Consultant or the hair industry?