Your Hair Story

Your Hair Story

Please fill out this form to the best of your ability. The more information you provide us with, the more we are able to help address your goals and needs.

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General Information

Please select one
Name*
Address*
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How did you hear about Simply Erinn's?
Please check all that apply.

Your Health

List any and all medications
Food, medication, color, other. Please list NONE if you have no allergies.
Please list type

Your Scalp

Do you have scalp concerns?
Please select all that apply.
If you have any scalp concerns, what parts of your scalp are affected
Have you been seen by a Dermatologist/Trichologist?
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Your Hair History

Who usually cares for your hair?

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Such as a perm, relaxer, or keratin treatment
Please line up ALL your hair products and take a picture of them as a group.
Accepted file types: jpg, png, gif, Max. file size: 20 MB.
Pictures of your hair and your current products will help us make your consultation as productive and helpful as possible. Please upload the necessary pictures below:
Please upload a front-facing picture from your collarbone up.
Accepted file types: jpg, png, gif, jpeg, Max. file size: 20 MB.
Please upload a side-facing picture for one side of your head.
Accepted file types: jpg, png, gif, jpeg, Max. file size: 20 MB.
Please upload a side-facing picture of the other side of your head.
Accepted file types: jpg, png, gif, jpeg, Max. file size: 20 MB.
Please upload a picture of the back of your head.
Accepted file types: jpg, png, gif, jpeg, Max. file size: 20 MB.
Consent*