Application - Thinning to Thickness

What are your hair wellness goals? SELECT ALL THAT APPLY.

Growth

Thickness

Shine

Strength

Texture

Your age?

18-30

31-44

45+

How often do you consume refined carbohydrates (White bread, chips, soda, candy)?

never

rarely

sometimes

often

Which of these do you tend to experience?

I feel tired after meals

I crave sweets all the time, even when I am full

I become lightheaded or moody when I don't eat

Name

First Last

Phone

Email

Phone

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