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Hairloom Extensions and Styling Inc.

Product Recommendation Form 1

Answer a few quick questions — it only takes a few minutes.
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Information
Hi, I’m Shaina! 🌿 I’m a Hair Extension Specialist, Associate Trichologist, and Hair & Scalp Care Consultant. I work with women (and men!) who want healthier hair, a happier scalp, and a routine that actually fits their life. If you found your way here, you’re probably hoping to improve something about your hair or scalp. You’re in the right place! This questionnaire helps me get to know your hair history, your scalp, your concerns, and your goals. From there, I’ll build a routine made just for you, based on your hair type, your lifestyle, and what your scalp really needs. No more guessing or product hopping. Your personalized routine is included with your product purchase, and I’ll be with you every step of the way to walk you through it. The products I recommend are vegan, cruelty-free, gluten-free, and free from sulfates, parabens, and non-soluble silicones. What makes this different is the support. You’re not just getting a product list. You’re getting education, guidance, and a long-term plan so your hair and scalp can truly improve over time. Please double-check your phone number and email (and your Instagram handle if you have one) so I can send your routine and follow up with you. You can expect to hear from me within 3–6 business days. I’m so glad you’re here, and I can’t wait to help you love your hair again. With love, Shaina 🌿
Please enter your first and last name (required)
When is your birthday? (required)
Where are you located? City/State/Country (required)
What is your email address? (required)
What is you phone number? (required)
What your Facebook Instagram and/or Tik Tok Handle? (required)
How did you find me? (required)
Let' talk about your hair and scalp, check all that apply (required)
Your hair is... (required)
Your hair is... (required)
What shampoo and conditioner are you currently using? (required)
Do you use a shower filter? (required)
What type of water do you have at home? (required)
Do you have any medical conditions that may affect your scalp or hair? (thyroid, PCOS, postpartum, auto-immune, etc.) (required)
Are you familiar with ingredients in beauty products and how these things can affect your overall health? (required)
How would you like me to get in touch with you with my product recommendations? (required)
What is your price range for a new haircare regimen? Our VIPS save 15%+ off every order (required)
Would you want to be able to share and link the products for the business side (must be 18+) (required)
Do you have any known allergies to fragrances, essential oils, or botanical extracts? (required)
Please upload any pictures showing your current hair and or scalp concerns. (not required but helpful)
JPG or PNG. Large phone photos are optimized automatically. Selected — tap change to pick another.
Final step
Your contact details
We’ll use this to attach your responses.