ASK DEREK Consultation & Maintenance Advice( 30 minutes ) Name* First Tel. #*Email* Medication/Drugs?* Yes No e.g.Treat or prevent diseaseMedical Conditions* Yes No e.g. Lupus, Sickle Cell, High Blood PressureHave you seen a Tricologist ?* Yes No Have you seen a Dermatologist ?* Yes No Describe your Hair Type from the Principles of Hair:* Bald Braided Locs Afro Curls/Coils Weave Wig Kinky Straight Wrap What is your Hair Issue?*Chemically Treated HairRelaxer* Yes No Colouring* Yes No Are you prepared to cut your hair short, if you have suffered traction ALOPECIA or related hair loss?* Yes No 30 minute consultation & maintenance advice* Telephone Skype Zoom
