Treasuring Tresses - Holistic Hair & Scalp Wellness

Scalp Analysis Consultation

Confidential client record for scalp wellness, healthy hair support, and personalized luxury head spa care.

This form helps Treasuring Tresses understand your scalp, hair history, wellness background, and care goals before recommendations are made.

Completed by Client

Client Information

Full Name Date of Birth Phone Number Email Address Today's Date Referred By

Completed by Specialist

Treatment & Product Recommendations

Recommended Treatment Recommended Visit Frequency Recommended Products / Ingredients At-Home Care Instructions Follow-Up Goals / Progress Markers

Consent & Signature

Client Acknowledgement

I confirm that the information provided is accurate to the best of my knowledge. I understand that this scalp analysis is for wellness purposes only and does not constitute a medical diagnosis. I consent to the recommended scalp treatments and authorize Treasuring Tresses to document my scalp health progress over time. I understand that results may vary and that consistent care yields the best outcomes.

Client Signature Date Specialist Signature License #

Scalp Analysis Consultation

Client Information

Hair & Scalp History

Health & Lifestyle

Scalp Analysis Machine Findings

Treatment & Product Recommendations

Client Acknowledgement