Name:   Zip Code:         1.) Sex Male Female 2.) Are your roots/scalp? Oily Dry Normal 3.) Are the ends of your hair? Oily Dry Normal 4.) If you had to describe your hair, which one of the following would correspond: Condition: Flat with no volume Brittle and dull Normal Texture: Fine Thick 5.) Is your scalp either sensitive or irritated? Yes No 6.) Do you suffer from one of the following? Dandruff Hair Loss/Thinning Hair None of them