Please complete all required fields to the best of your ability. I will be in touch with follow up questions within 1-2 business days. Consultations are conducted T-Fr.

All client health information is confidential between holistic health consultant & client. 

Highest Health & Blessings to you.

-Amena

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Name *

First

Last

Email *

Email

Confirm Email

What part of the world are you in? *

list city & state/ country

Welcome to your Hair Healing consultation! All questions are required fields. If something doesn't apply put n/a or not applicable. *Got it!

select got it to continue

Are you currently natural, transitioning or considering going natural? *

TRANSITIONING ONLY: How long have you been transitioning? *

list approximate timeframe as best you can recall

When did you go natural? Or have you always been natural? *

if applicable, list the date or year you fully transitioned and cut all relaxed, permed or straight ends?

Why did you go natural or are transitioning to/considering going natural? *

I like to get to know my clients. please explore & share your why’s here. be as brief or detailed as you like. 🙂

What is your hair type? *

type 4-kinky/coily, type 3-curly or type 2-wavy? it’s ok if you don’t yet know

List all products you are currently using for your hair care regiment. *

shampoos, conditioners, stylers and any other treatments and oils

How often do you shampoo & condition your hair? How often do you deep condition? *

weekly, bi weekly, monthly…never

When is the last time you had your ends trimmed? *

Do you color your hair? If yes, is it chemical or pure henna? how often and what brand(s)? *

If color is done by a professional and brand is unknown that is ok but if you can find out it can be helpful in resolving issues

How do you style your hair majority of the time? *

wash & go, twists, twists outs, braids, braid outs, blown dry, wigs, etc…

Do you heat style your hair? If yes, how often and is it blow dry only or flat iron/straightening comb? *

Do you wear braid or twist extensions? If yes, how often do you wear them and how long do you leave them in on average? *

Do you wear wigs and head wraps? If yes, how often would you say you wear them? *

in your answer please specify wig, head wrap or both

Do you have any allergies? *

please list ingredients or foods to which you know you are allergic

Are you on any medication? *

medications can interfere with our hair & scalp health and dictate the types of products we can use so please list all medications pharmaceutical or herbal

What are your hair and scalp concerns/issues? *

be as detailed as you like here

What do you want to gain from this consultation to make your hair journey successful? *

be as detailed as you need here

Please share any questions you'd like answered when I return your custom hair care regiment? *

At your earliest convenience please send a recent image or video of your hair wet & dry to amena@basiqueopulence.com or 323.334.0406 with your first & last name. Upon receipt I will begin working on your custom hair care regiment. On it!

select on it to continue – no selection required

Thank you for completing step 1 of your hair healing consultation. You're on your way to the best head of hair of your life! I'll be in touch within 2 business days (Tu-Fri) with next steps.

• looking forward to it!

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