TricHolistic Profile

*Please complete this form in its entirety; fill in every field in order to submit. Fields that do not apply to you should be filled in with "N/A" only. Thank you for your attention!

Employment Environment:

Do you need someone other than yourself to make a financial decision to
begin your TricHolistic Program? (If so, we ask they be present during
your appointment.)

How do you relieve stress? (Check all that apply)

Scalp Condition: (Check all that apply)

Hair Condition: (Check all that apply)

Hair dryer temperature: (Check all that apply)

By submitting this TricHolistic Profile Web Form, I solemnly declare that the information that I have given on this profile is correct in all respects. I understand that supplying false information could hinder my treatment.