AT - HOME RECOVERY SYSTEM

Shop by Concern — Client Questionnaire

Tell us where your hair is today. Your answers help us match you to the

right AMNI™ products and build your personalized 12-week restoration plan.

Tell us where your hair is today. Your answers help us match you to the right AMNI™ products and build your personalized 12-week restoration plan.

1 Let’s Get Acquainted

I Let’s Get Acquainted

____________________________________________________________

1. First Name *

2. Last Name *

3. Phone *

4. Email *

II Your Hair Story

____________________________________________________________

5. How would you describe your hair? *

Wavy

Curly

Coily / Kinky

Relaxed

Locs

Not sure

6. Which concerns brought you to AMNI™? *

Psoriasis

Dry hair

Flaky Scalp

Dry Scalp

Breakage

Shedding

Thinning Edges

Thinning Hair

Brittle Hair

Lack of Moisture

Hair Won't Grow

Something Else

Select all that apply

7. Of those, which feels most urgent right now? *

8. How long have you been dealing with these concerns?

Under 3 months

3-12 months

1-3 years

3+ years

III Your Routine & Goals

____________________________________________________________

9. What does your current wash day look like? *

How often you wash & products you use

10. Are you currently using any of these? *

Relaxer

Color

Braids

Weave / Extensions

Heat Styling

None of these

Select all that apply

11. What is your #1 hair goal for the next 12 weeks? *

Length / Growth

Stronger hair / less breakage

A calmer, healthier scalp

Moisture & softness

Fuller edges & density

12. What's the best time to call you? *

13. How did you hear about AMNI™, and anything else we should know? *