Hair Health Form | Vibez Beauty Bar

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Hair Health Assessment

Name

Email

Phone

How did you hear about us?

Client Referral

Google

Instagram

Facebook

TikTok

Website

Other

Age Group of Client Being Serviced?

12 & Below

13-20 y/o

21-35 y/o

36-50 y/o

51 & Above

Hair Texture

Relaxed

Transitioning

Natural, Type A (Straight/Wavy)

Natural, Type B (Wavy/Curly)

Natural, Type C (Curly/Tight Curly)

Just Natural

Are you in search of a long term hairstylist?

Yes

No

Allergies & Medications

Photos of Hair

Upload

Tell Me About Your Hair: Overall hair health (poor, fair, good,excellent) ; Currently Experiencing any hair loss/breakage? ; When was your last cut/trim? (___ months ago) ; Are there any chemicals on your hair? (relaxer, hair color) ; Normal hair/scalp state? (normal, dry, oily) ; How often do you shampoo/condition your hair? ; What hair products do you use? Likes & Dislikes about hair? Hair Goals

Thanks for your information! I look forward to discussing future plans and treatments for you at your next appointment. See you soon!!

@ Vibez Beauty Bar, 2022

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