Includes a customized program for men written by the Hair Dr. and also Lisa Akbari’s Hair Nutrition System which includes a two month supply of three care products: 1) Cleansing, Clarifying, and Balance Shampoo, 2) Deep Penetrating, Protein Moisture and Stabilizing Conditioner; 3) Hair Vitamins Leave-in Conditioner and two support products which includes: 4) Oil Sheen in a Jar and 5) Moisture Plus Moisturizer.
Lisa Akbari Hair Products and Programs
PLEASE FILL OUT > Lisa Akbari Hair and Scalp Questionnaire
CUT AND PASTE and email to email@example.com once you pay for your order.
Be sure to send a photo of problem areas.
Name: First _____________Last ____________________
Address _________________ City ________________ State___________________ Zip ___________
Phone number: _cell _________________ #2 number ____________________
Is your hair Natural? ____
Do you have chemicals in your hair? _____
What type of chemical? ________________
If your hair is chemically treated? How often?
Is your hair long? Estimate how many inches? ____________
Does your hair feel dry? _____ Does your hair look dry? ____
Hair breaking? ____Daily? _____ When combing? ______
How do you wear your hair:
Does your- Scalp itch? Yes __ No __ Scalp flake? Yes __ No __ Feel tender and sore? Yes __ No __
Does your scalp burn? Yes __ No __ Does your scalp have bumps? Yes __ No __
Does your scalp have bald spots? Yes __ No __ Short broken areas? Yes __ No __
Any Bald Spots: ____ Location of any bald spots: _________________
How long have you had balding? _________
Do you Shampoo your hair? _____How often? ______
Do you Condition your hair? ___ How often? ____
Do you use leave-in conditioner, if so how often?: _______
Describe your hair regimen: Other issues or challenges/ Tell us your hair story: