Restoration Assessment | Khavoni's Mane

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Holistic Restoration Assessment

This guided assessment was created to help uncover patterns that may be connected to changes within the hair, scalp, stress levels, hormonal shifts, inflammation, and overall wellness. Your body often communicates through patterns before clarity fully arrives, and this experience was thoughtfully designed to help approach your next steps with greater understanding, intention, and support.

While this assessment is not intended to diagnose, it was created to help guide you toward the consultation experience and support pathway that may best align with where you are right now.

First name*

Last name

Email*

Phone

1. What brought you here today?*

Hair shedding or thinning

Scalp irritation, itching, flakes, or buildup

Breakage or weak strands

Slow hair growth

Hormonal or internal wellness concerns

Nutritional support

I’m not sure, I just know something feels off

2. How long have you noticed these changes?*

Less than 3 months

3–6 months

6–12 months

Over 1 year

It comes and goes

3. What area feels most concerning right now?*

Edges / hairline

Crown / top of scalp

Overall thinning

Scalp condition (burning, itching, etc.)

Hair strength / breakage

Internal health and energy

4. Which internal patterns are you currently noticing?*

Fatigue or low energy

Stress or overwhelm

Hormonal changes / peri-menopause / menopause

Digestive changes or bloating

Inflammation or autoimmune concerns

None that I’m aware of

5. How would you describe your current hair/scalp routine?*

Consistent and supportive (routine salon visits)

I try, but I need structure

I use a lot of products but still feel stuck

I’m not sure what my scalp actually needs

I’ve stopped doing much because I’m discouraged

6. Have you received professional support for this concern before?*

Yes, from a licensed hair care professional

Yes, from a dermatologist, trichologist or medical provider

Yes, from a nutritionist or dietician

Yes, but I still need more clarity

No, this is my first step

I’ve tried researching on my own

7. What type of support feels most helpful right now?

A professional consultation

A clear at-home plan

In-clinic treatments

Nutrition and internal wellness support

A full hair & wellness strategy

I need help figuring that out

8. What are you hoping to walk away with?

Clarity on what may be contributing to my hair / scalp concerns

A plan I can follow

Support with hair and internal wellness together

Better consistency and accountability

A trusted professional to guide me

All of the above

Khavoni • Be healthy in mind, body, and crown.

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