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Hair Nutrition Assessment

Birthday
Month
Day
Year
I eat breakfast...
Hardly ever
2 or 3 times per week
Everyday
I eat lunch...
Hardly ever
2 or 3 times per week
Everyday
I eat dinner...
Hardly ever
2 or 3 times per week
Everyday
How many servings of protein do you consume per day?
One
Two
Three
Four or more
Other
How many servings of nutritional shakes do you consume per day?
One
Two
Three
Four or more
Other
How many servings of water do you consume per day?
8 ounces
16 ounces
24 ounces
32 ounces
64 ounces or more
Other
I eat healthy snacks...
Hardly ever
Once per day
2 or 3 times per day
I eat healthy vegetables...
Hardly ever
Once per day
2 or 3 times per day
I eat healthy fruit...
Hardly ever
Once per day
2 or 3 times per day
The carbs I choose to eat most days...

Click all that apply.

Today's Date
Month
Day
Year

Privacy and Confidentiality Notice


At Unofficial Blonde Studios, we take your privacy seriously. We are committed to protecting your personal health information.


All information you provide to us, including medical records, personal details, and any other health-related data, will be kept strictly confidential and used only for the purposes of providing you with quality care. We will not share your information with any third parties without your explicit written consent, except as required by law.


Your trust is important to us, and we ensure that your health information is handled with the highest level of security and privacy.


If you have any questions regarding our privacy practices, please feel free to contact us at Contact@UnoffcialBlonde.com or 443-651-1895.

Hair Nutrition Assessment + Rx & Supplements

Birthday
Month
Day
Year
I eat breakfast...
Hardly ever
2 or 3 times per week
Everyday
I eat lunch...
Hardly ever
2 or 3 times per week
Everyday
I eat dinner...
Hardly ever
2 or 3 times per week
Everyday
How many servings of protein do you consume per day?
One
Two
Three
Four or more
Other
How many servings of nutritional shakes do you consume per day?
One
Two
Three
Four or more
Other
How many servings of water do you consume per day?
8 ounces
16 ounces
24 ounces
32 ounces
64 ounces or more
Other
I eat healthy snacks...
Hardly ever
Once per day
2 or 3 times per day
I eat healthy vegetables...
Hardly ever
Once per day
2 or 3 times per day
I eat healthy fruit...
Hardly ever
Once per day
2 or 3 times per day
The carbs I choose to eat most days...

Click all that apply.

Today's Date
Month
Day
Year

Privacy and Confidentiality Notice


At Unofficial Blonde Studios, we take your privacy seriously. We are committed to protecting your personal health information.


All information you provide to us, including medical records, personal details, and any other health-related data, will be kept strictly confidential and used only for the purposes of providing you with quality care. We will not share your information with any third parties without your explicit written consent.


Your trust is important to us, and we ensure that your health information is handled with the highest level of security and privacy.


If you have any questions regarding our privacy practices, please feel free to contact us at Contact@UnoffcialBlonde.com or 443-651-1895.

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