Heather Nicole

Email *

Is your Scalp *

Oily

Dry

Normal

Is your Hair *

How Often Do you Wash your Hair? *

Daily

Every Other Day

3 Days +

Every 2+ Weeks

What is your Hair Texture *

Frizzy

Dry/Dry Ends

Wavy

Curly

Coarse

Damaged

Bleached

Do you... *

Blow Dry

Air Dry

Both

What is your biggest hair concern/ issue you'd like to address? (I.E. Dandruff, itchy scalp, hair loss) *

Tell me About Your Skin! Check ALL that apply *

Dry / sensitive

Oily

Combo

Acne Prone

Sun Damage

Wrinkles

Under Eye Bags

Any Allergies you're aware of? *

What is your name? *

What is your instagram? *

How do you wan me to contact you (Instagram, Call, Text) *

Phone Number

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