Step 1 of 2 50% ABOUT YOURSELFName* First Last Email* Date of Birth* Date Format: MM slash DD slash YYYY Gender*FemaleMalePlease describe your race/ethnicity.*Where do you currently reside (if you travel a lot, where do you spend the most time)?* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code What is your occupation?What oral and topical medications do you currently take by mouth and/or apply to your skin (including the scalp)? (Write 'none' in the space provided if you do not take any medications)OralTopicalNoneAre you currently pregnant?*YesNoHave you had a child in the past year?*YesNoHave you been seen by a dermatologist within the past year?*YesNoHave you been diagnosed with a particular skin or scalp condition?*YesNoAre you happy with your dermatologist?*YesNoHave you been to a hair stylist within the past year?*YesNoHow often do you go?*More than once a weekOnce a weekEvery two weeksEvery three weeksOnce a monthBetween once a month and every two monthsEvery three months (4 times a year)3 times a year2 times a year1 time a yearWhat hair services do you have when you go? (Check all that apply)* Wash/shampoo Hair cut/trim Partial shave/buzz Blow dry Hooded dryer Roller set Cornrolls Twists (along the scalp) Double-stranded twists Weave/Extensions Wrap Stretching Styling using heat appliances such as a flat iron, curling iron, Marcel irons and/or Hot/pressing combs Hair treatments (Color, Keratin, Relaxer, Texturizer, Curly Perm, etc.) Other Please specify Other?*Are you happy with your current stylist?*YesNoDo you use hair accessories (rubber bands, clips, barrettes, hair/Bobby pins, hair bands, etc.)*YesNoPlease list the hair accessories that you use (ex: rubber bands, clips, hair/Bobby pins, hair bands, etc.)*What is your PRIMARY hair style (the way that you wear your hair most of the time)? (Please choose only one answer.)*Pulled back into pony-tails, buns, or rollsLoose without much tension or pullingBraids or twists along the scalp such as cornrollsLoose with some braids or twists along the scalp such as cornrollsIndividual braids or twistsExtensions, weaves, or wigs that require the use of purchased hair to add to your existing hairBantu knotsPartial shave/buzzWhat is your SECONDARY hair style (the second most frequently worn style)? (Please choose only one answer.)*Pulled back into pony-tails, buns, or rollsLoose without much tension or pullingBraids or twists along the scalp such as cornrollsLoose with some braids or twists along the scalp such as cornrollsIndividual braids or twistsExtensions, weaves, or wigs that require the use of purchased hair to add to your existing hairBantu knotsPartial shave/buzzI do not have a secondary hair styleWhat is your SHORTEST hair length? (Please measure the extended length of the SHORTEST section of your hair.) Note: Do not include breakage that usually occurs around the edges (the perimeter) of your hair.*SHORTEST hair length (inches)What is your LONGEST hair length? (Please measure the extended length of the LONGEST section of your hair.) Note: Do not include breakage that usually occurs around the edges (the perimeter) of your hair.*LONGEST hair length (inches)Which option below describes your natural hair color? (Please choose only one answer.)*BlackDark BrownBrownLight BrownBlondeRed/OrangePlease indicate your level of satisfaction with your hair.*Very happyHappyNeutral (neither happy nor unhappy)UnhappyVery unhappyWhich of the following, if any, do you experience as a problem or a concern with your hair? (Select all that apply)* Breakage Hair color/dye fading Dandruff/flaking Dry scalp Dullness Dry/straw-like Fly-aways Fragile/brittle Graying Grows too slow Itchy scalp No body/volume Oily scalp Split ends Thinning/losing hair Too coarse Too curly Too fine/thin Too frizzy Too oily Too straight Doesn't stay straight Doesn't stay curly Environmental humidity Unruly Other (Be very specific. Can be based on your hair quality, hair density, hair diameter, hair length, how the hair behaves or how it looks.) Please specify Other?*(Be very specific. Can be based on your hair quality, hair density, hair diameter, hair length, how the hair behaves or how it looks.)Which of the following describes(s) your approach to solving your hair problems? (Select all that apply)?* Seek advice/treatment from a dermatologist or other physician Seek advice/treatment from a hair stylist Use the advice of a relative or a friend Use over-the-counter remedies/products Get advice from the Internet Read self-help books Use home remedies/products I do not treat my hair problem I do not have hair problems or concerns Other Please specify Other?*(Be very specific. Can be based on your hair quality, hair density, hair diameter, hair length, how the hair behaves or how it looks.)About Yourself - WorkoutDo you workout on a regular basis (3 or more hours/week)?*YesNoDuring your workout, do you wear your hair pulled up (secured with hair accessories i.e., rubber band, barrettes, hair pins, clips, etc.)?*YesNoDuring your workout, do you wear your hair hanging down?*YesNoDuring your workout, do you sweat in your scalp?*YesNoDuring your workout, do you wear a headband to hold your hair back out of your face?*YesNoDuring your workout, do you wear a scarf?*YesNoAbout Yourself - SwimDo you swim on a regular basis (3 or more hours/week)?YesNoDo you wear a swim cap when you swim?*YesNoAbout Yourself - Outside SportsDo you participate in outside sports/where you can be out in the sun for over 10 hours/week on a regular basis?*YesNoDo you wear a hat, cap, or scarf when you participate in outside sports?*YesNoDo you wear a hat, cap, or scarf when you participate in outside sports?*YesNoWhat type of products are you willing to use?*Safe products that work to get my hair in the most desirable stateOnly products that are considered to be 'natural'Will you please describe what you would ultimately like to achieve with your hair?* HAIR TREATMENT: Hair ColorIs hair color used on your hair?*YesNoHow was your hair color applied? (Please select based on your most recent application.)*Self-appliedProfessionally appliedHow often is hair color applied to your hair?*Every 1 to 3 weeksEvery 1 to 2 monthsEvery 3 to 5 monthsEvery 6 to 8 monthsEvery 9 to 12 monthsWhat specific brand was used on your hair? (Please select based on your most recent application. Write "don't know", if unsure.)*What specific color was used on your hair? (Please select based on your most recent application. Write "don't know", if unsure.)*Which options below best describes the type of hair color used? (Please select all that apply for your most recent application.)* Rinse Semi-permanent Permanent Highlights Lowlights Henna Don't know What was your reason(s) for getting hair color? (Please select all that apply based on your most recent application.)* To cover grey hair For fashion or to obtain a classy or unique look For shine Other Please specify Other?*HAIR TREATMENT: RelaxerDo you have a relaxer?*YesNoHow was your relaxer applied? (Please select based on your most recent application.)*Self-appliedProfessionally appliedHow often is your hair relaxed?*Every 4 weeks or lessEvery 5 to 7 weeksEvery 8 to 12 weeksEvery 3 to 4 monthsEvery 5 to 7 monthsEvery 8 to 12 monthsLess than 1 time per yearWhat specific brand of relaxer was used on your hair? (Please answer based on your most recent application. Write "don't know", if unsure.)*Which option below best describes the strength of your relaxer? (Please select based on your most recent application.)*Mild or for color treatedNormal or medium strengthResistant or super strengthDon't knowWhat type of relaxer was used on your hair? (Please select based based on your most recent application.)*Lye based (usually a professional no-mix product)No-lye based (usually purchased over-the-counter and is a product that requires mixing)Don't knowWhat was your reason(s) for getting a relaxer? (Please select all that apply based on your most recent application.)* For manageability/ease of combing Hair growth For a straight style To prevent frizz Other Please specify Other (Relaxer)?*HAIR TREATMENT: TexturizerDo you have a texturizer (a treatment that loosens the curl without completely straightening it)?*YesNoHow was your texturizer applied? (Please select based on your most recent application.)*Self-appliedProfessionally appliedHow often is a texturizer applied to your hair?*Every 4 weeks or lessEvery 5 to 7 weeksEvery 8 to 12 weeksEvery 3 to 4 monthsEvery 5 to 7 monthsEvery 8 to 12 monthsLess than 1 time per yearWhat specific brand of texturizer was used on your hair? (Please answer based on your most recent application. Write "don't know", if you are unsure.)*What type of texturizer was used on your hair? (Please select based based on your most recent application.)*Lye based (usually a professional no-mix product)No-lye based (usually purchased over-the-counter and is a product that requires mixing)Don't knowWhat was your reason(s) for getting a texturizer? (Please select all that apply based on your most recent application.)* For manageability/ease of combing Hair growth For a straight style To prevent frizz Other Please specify Other (Texturizer)?*HAIR TREATMENT: Straightening TreatmentDo you have a Keratin or Brazilian straightening treatment?*YesNoWhat is the brand name of the Keratin or Brazilian straightening treatment used? (Please answer based on your most recent application. Write "don't know", if unsure.)*How often do you get the Keratin or Brazilian straightening treatment?*Every 1 to 3 weeksEvery 1 to 2 monthsEvery 3 to 5 monthsEvery 6 to 8 monthsEvery 9 to 11 monthsEvery 12 to 18 monthsWhat was your reason(s) for getting the Keratin or Brazilian straightening treatment? (Please select all that apply based on your most recent application.)* For manageability/ease of combing Hair growth For a straight style To prevent frizz To have a temporary straightened look Other Please specify Other (Keratin or Brazilian)?*HAIR TREATMENT: Curly PermDo you have a curly perm such as Wave Nouveau, Care Free Perm, Iso Perm, etc?*YesNoWhat brand of curly perm treatment was used on your hair? (Please answer based on your most recent application. Write "don't know", if you are unsure.)*How often do you get the curly perm treatment?*Every 1 to 3 weeksEvery 1 to 3 monthsEvery 4 to 6 monthsEvery 7 to 9 monthsEvery 10 to 12 monthsEvery 13 to 18 monthsWhat was your reason(s) for getting the curly perm treatment? (Please select all that apply based on your most recent application.)* For manageability/ease of combing Hair growth For loose-curled style Healthy hair Other Please specify Other (Curly Perm)?*HEAT PROCESSINGAre thermal appliances used on your hair? (This would include applying heat to the hair with a hooded dryer, blow dryer, flat iron, hot comb, etc.)*YesNoPlease indicate the different ways your hair is heat processed.* Flat iron Curling iron Marcel irons Hot/pressing comb Blow dryer Hooded dryer Hot curling brush Hot rollers How often is your hair heat processed? (Please refer to the items listed above for a list of heat processing methods.)*More than once a dayOnce daily4 to 6 days per week2 to 3 days per week1 time per weekEvery 2 to 3 weeksEvery 4 to 5 weeksEvery 6 to 8 weeksEvery 9 to 12 weeksEvery 3 to 4 monthsEvery 5 to 6 monthsEvery 6 to 12 monthsLess than 1 time per yearHeat Processing - Blow DryerIs a blow dryer used on your hair?*YesNoWhat's the typical temperature setting on the blow dryer during use?*Low range temperature (300-350 oF or 149-177 oC)Medium range temperature (351-420 oF or 178-216 oC)High temperatures (over 420 oF or 216 oC )Don't knowHair Processing - Hot Curling BrushIs a hot curling brush used on your hair?*YesNoHow many times is the hot curling brush passed through your hair (per section)?*1-23-45 or moreDon't knowWhat's the typical temperature setting on the hot curling brush during use?*Low range temperature (300-350 oF or 149-177 oC)Medium range temperature (351-420 oF or 178-216 oC)High temperatures (over 420 oF or 216 oC )Don't knowHair Processing - Hot Curling IronIs a hot curling iron used on your hair?*YesNoHow many times is the hot curling iron passed through your hair (per section)?*1-23-45 or moreDon't knowWhat's the typical temperature setting on the hot curling iron during use?*Low range temperature (300-350 oF or 149-177 oC)Medium range temperature (351-420 oF or 178-216 oC)High temperatures (over 420 oF or 216 oC )Don't knowHair Processing - Flat IronIs a flat iron used on your hair?*YesNoHow many times is the flat iron passed through your hair (per section)?*1-23-45 or moreDon't knowWhat's the typical temperature setting on the hot curling iron during use?*Low range temperature (300-350 oF or 149-177 oC)Medium range temperature (351-420 oF or 178-216 oC)High temperatures (over 420 oF or 216 oC )Don't knowHAIR REGIMENIf an item does not pertain to you, please write or choose 'None'.What is the name of the PRIMARY shampoo/cleansing product or agent used on your hair? (Please answer based on your most recent cleansing.)*What is the PRIMARY type of shampoo/cleansing product/agent used on your hair? (Please choose only one answer based on your most recent cleansing.)*2 in 1 shampoo-conditionerMoisturizingClarifyingVolumizingHydratingSmoothingFor oily hairFor normal hairFor dry hairDandruff/MedicatedOtherPlease specify Other, PRIMARY type of shampoo/cleansing*If you use more than 1 shampoo, what is the name of the SECONDARY shampoo/cleansing product/agent used on your hair? (Please answer based on your most recent cleansing.)*What is the SECONDARY type of shampoo/cleansing product/agent used on your hair? (Please choose only one answer based on your most recent cleansing.)*None2 in 1 shampoo-conditionerMoisturizingClarifyingVolumizingHydratingSmoothingFor oily hairFor normal hairFor dry hairDandruff/MedicatedOtherPlease specify Other, SECONDARY type of shampoo/cleansing*If you use more than 1 type of shampoo, what is the SECONDARY type of shampoo/cleansing product/agent used on your hair? (Please choose only one answer based on your most recent cleansing.)*None2 in 1 shampoo-conditionerMoisturizingClarifyingVolumizingHydratingSmoothingFor oily hairFor normal hairFor dry hairDandruff/MedicatedHow often is your hair cleansed?*Daily4 to 6 days per week2 to 3 days per week1 time per weekEvery 2 to 3 weeksEvery 4 to 5 timesEvery 6 to 8 weeksEvery 2 to 3 monthsEvery 4 to 6 monthsWhat is the name of the conditioner used after cleansing your hair? (Please answer based on your most recent cleansing.)*What "TYPE" of conditioner is used after cleansing your hair? (Please answer based on your most recent cleansing. Choose only one answer.)*NoneRinse outLeave-inWhat is the "NAME" of the PRIMARY leave-in product used on your hair? (Please answer based on your most recent cleansing.)*What is the PRIMARY type of leave-in product used on your hair? (Please choose only one answer based on your most recent cleansing.)*NoneOilGelCreamMousseSpritzHair spraySerumWaxPuddingHair honeyConditionerIf you use more than 1 leave-in product, what is the name of the SECONDARY leave-in product used on your hair? (Please answer based on your most recent cleansing.)*What is the SECONDARY type of leave-in product used on your hair? (Please choose only one answer based on your most recent cleaning.)*NoneOilGelCreamMousseSpritzHair spraySerumWaxPuddingHair honeyPlease examine these combs, consider the tooth spacing on the comb and not the brand, style or design. What type of comb do you use to style and manipulate your hair?* Wide-toothed Medium-toothed Fine-toothed None Please examine these brushes, consider the bristle type and not the brand, shape or design. What type of brush do you use to style and manipulate your hair?Natural BoarPlastic or RubberWoodNoneWhat else do you use to style and manipulate your hair? (Select all that apply)* Fingers to twirl or rake through hair Pick Rollers Pin curls Other Please specify Other, (Style/Manipulate hair)*How often do you manipulate your hair? (Styling and manipulation includes combing, brushing, twirling or raking through with fingers, etc.)3 or more times a day1 or 2 times a day4 to 7 times per week1 to 3 times per week1 to 4 times a monthevery 2 to 3 monthsevery 4 to 6 monthsWhat is the usual state of your hair when you style or manipulate it? (Styling and manipulation includes combing, brushing, twirling or raking through with fingers, etc.)WetDampCompletely DryCommentsThis field is for validation purposes and should be left unchanged.