Scalp & Hair Health Wellness Questionnaire

Welcome!

My name is Mandie Sue, and I’m the founder of The Scalp Lounge USA, where we specialize in holistic scalp wellness and advanced hair restoration services. With years of experience helping clients restore their confidence and renew their scalp health, I’m here to guide you every step of the way.

Please take a few minutes to complete this Scalp & Hair Health Questionnaire so we can better understand your scalp condition, hair type, and goals. Once I’ve reviewed your responses, I’ll recommend the ideal scalp service designed specifically for your needs.

Your journey to a healthier scalp and stronger, more vibrant hair starts here — and I’m so excited to help you begin.

Our Standards for Scalp & Hair Care Products:
At The Scalp Lounge USA, we use only the highest quality products backed by clinical research and safe, natural ingredients. Our products are:

  • Clinically tested and proven effective for hair loss and scalp health.

  • Free from harmful additives: no sulfates, parabens, gluten, or harsh chemicals.

  • Vegan and cruelty-free, using only gentle, non-toxic, and scalp-friendly ingredients.

Please complete this form thoroughly so we can recommend the service best for your hair and scalp. Thank you for trusting me with your hair wellness journey, and welcome to The Scalp Lounge USA—where healthy hair begins at the root!

1. Name, Phone & Email Information:

2. How You Found Us

3. Scalp Condition

4. Current Scalp Experience

5. Hair Washing

6. Scalp History & Conditions

Do you have a history of scalp conditions? (E.g., psoriasis, seborrheic dermatitis, eczema, alopecia, etc.)

7. Recent Hair Treatments

8. Experience Hair Stress

9. Scalp & Hair Home Health Care

10. Ask us questions or share with us what you need.

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