ALL NATURAL HAIRCARE

BY

KENDRA

CONSULTATION FORM

NAME _______________________________DATE___________________

PHONE #_____________________________________________________

ADDRESS____________________________________________________

CITY____________________STATE__________________ZIP__________

BIRTHDATE__________________________________________________

HOW DID YOU HEAR ABOUT “ALL NATURAL?”___________________

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DO YOU TAKE ANY MEDICATION?______________________________

HAVE YOU EVER HAD YOUR HAIR BRAIDED OR LOCKED BEFORE?

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DO YOU HAVE ANY CONCERNS ABOUT LOCKED OR BRAIDED ____

STYLES?___________________________________________________

DO YOU HAVE ANY PROBLEMS WITH YOUR HAIR OR SCALP?_____

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HAVE YOU HAD ANY PROBLEMS WITH HAIR USED FOR EXTENSION-

HUMAN OR SYNTHETIC?______________________________________

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CURRENT PRODUCTS USED

SHAMPOO________________________HOW OFTEN________________

COLOR___________________________HOW OFTEN________________

PERM____________________________HOW OFTEN________________

HOME STYLING METHODS

BLOWER____________________DRY NATURALLY?_______________

ROLLERS_____________________TYPE USED____________________