Picture Perfect Hair by Maiysha Johnson

Picture Perfect Consultation Form
“Making you look good makes me feel good”
(Please print legibly)
Note: All information contained in this form is kept confidential, and will only be used by Picture Perfect Hair by Maiysha Johnson solely for the purpose of determining hair care needs, suggested remedies and desired styling. Please bring form to consultation or email to [email protected].
Name: ______________________________________ Age: _______
Contact Phone: ___________________________________________
Email: __________________________________________________
How often do you shampoo your hair? _________________________
What type of shampoo do you use? ___________________________
What kind of conditioner do you use? __________________________
Is your hair thinning or breaking? ______________________________
List areas of hair loss or breakage. ______________________________
Any family history of thinning or balding? ________________________
What actions have you taken to prevent or correct hair loss or damaged hair?
______________________________________________________________________________
______________________________________________________________________________
What chemicals are you currently applying to your hair? ________________________________
How long is your hair? ___________________
How would you describe the density of your hair: fine, normal, or thick? __________________
Are you or do you? (check all that apply):
Dieting__ Allergies__ Medications__ Smoker__ Vitamins/Supplements__ Under Stress__
Hair Condition: (circle one) Straight Wavy Curly Excessively Curly
Oily os ow oc ec
Normal ns nw nc oec
Dry ds dw dc dec
How would you describe the condition of your scalp? (check one) oily__ dry__ Itchy__ flaky___
Do you or have you worn: braids, ponytails or cornrows? _______________________________
How would you describe your hairs condition? (check one) good ___ moderately good ___ fair ____ poor ___ seriously needs professional help ____
- Home
- About Maiysha
- Contact Maiysha
- Health & Wellness
- What's New @ PPH
- General & Technique Q&A
- Testimonial Submission
- Client Testimonials
- Hair Facts 1
- Hair Facts 2
- Before & After Gallery 1
- Before & After Gallery 2
- Gallery 1
- Gallery 2
- Gallery 3
- PPH Business Resource Center
- PPH How-To-Videos
- Consultation Form
- Deposit Payment
- Fusion Extension Deposit Pymt
- Purchase 100% Human Hair
- 100% Virgin Indian Remy Hair
- 100% Virgin Indian Remy Care
- Weave/Extension Hair Vendors
- Fusion Hair Care Maintenance
- Home
- About Maiysha
- Contact Maiysha
- Health & Wellness
- What's New @ PPH
- General & Technique Q&A
- Testimonial Submission
- Client Testimonials
- Hair Facts 1
- Hair Facts 2
- Before & After Gallery 1
- Before & After Gallery 2
- Gallery 1
- Gallery 2
- Gallery 3
- PPH Business Resource Center
- PPH How-To-Videos
- Consultation Form
- Deposit Payment
- Fusion Extension Deposit Pymt
- Purchase 100% Human Hair
- 100% Virgin Indian Remy Hair
- 100% Virgin Indian Remy Care
- Weave/Extension Hair Vendors
- Fusion Hair Care Maintenance