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Questionnaire

Hair Wellness Profile

Thank you for your interest in our Botanical Hair Care Collection! Your responses will help us better understand your hair care needs and create rituals that support healthy, beautiful hair.

Name

Email

Phone

About Your Hair

Which best describes your hair type?

Straight

Wavy

Curly

Coily

What are your primary hair concerns? (Check all that apply)

Hair loss/thinning

Dry Scalp

Itching

Breakage

Slow Growth

Dry Hair

Damaged hair

Other

Have you been diagnosed with alopecia?

Yes

No

Unsure

If yes, what type (if known)?

Do you believe any of the following may have contributed to your hair concerns?

Medication

Stress

Hormonal changes

Menopause

Genetics/family history

Unsure

Approximately how long have you experienced these concerns?

Less than 6 months

6-12 months

1-3 years

More than 3 years

Hair Care Ritual

How often do you wash your hair?

Weekly

Every 2 weeks

Monthly

As needed

Do you currently use conditioner?

Always

Sometimes

Rarely

Never

Which products do you regularly use? (Check all that apply)

Shampoo

Hair oil

Hair cream

Leave-in conditioner

Scalp treatment

Other

Do you wear protective styles?

Frequently

Occasionally

Rarely

Never

Do you chemically treat or relax your hair?

Yes

No

How often do you trim your hair?

Every 6–8 weeks

Every 3–4 months

Once or twice a year

Rarely

Product Interest

Which products are you interested in?

Renewal Botanical Shampoo

Rosemary Botanical Hair Oil

Rosemary Botanical Hair Butter

Additional comments or questions:

Thank you for sending us hair care answers.

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Relax. Release. Recharge.

Because wellness should feel as good as it works.

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