RevivScalp Hair Transformation

Welcome to The Scalp Renewal Experience, where luxury meets science to transform your hair care routine forever.

This exclusive program is designed for women like you —busy, ambitious, and always putting others first—who are ready to prioritize their self-care. Through innovative Japanese Head Spa treatments, customized scalp therapies, and expert guidance, you’ll uncover the secret to vibrant, healthy hair and a stress-free mind.

Imagine a world where every strand of hair radiates vitality and your scalp feels as refreshed as a new beginning. With just a few sessions, you’ll experience improved hair growth, a boost in confidence, and the tranquility you’ve been craving.

Complete the application form today and join the select group of 10 women transforming their hair care and self-care routines into something extraordinary. If you qualify, we’ll be contact to you via email or text messages to set up our consultaton to start this exciting journey together!

First Name *

Last Name *

Phone *

Email *

How do you know about us? *

Instagram

Facebook

TikTok

One of my friends or someone i know

Let's find out what's going on

Are you currently suffering from hair loss? *

Yes

Since when do you feel that your hair is falling out more than normal? *

Your hair loss and/or thinning of the strand is located in: *

Located in the form of circles or hairless patches in one or more places on the head.

In the front in the hairline areas.

All over the head

In the top of the head and frontal area.

It is breaking from the middle to the tips.

Are you currently undergoing any type of holistic or medical treatment? *

Yes

Hair Care Routine & lifestyle

How often do you wash your hair? *

Every day

Every other day

2 or 3 time a week

1 time a week

How often do you visit the hair salon? *

What do you do? Describe what kind of activity you do. (This gives us an idea of your lifestyle) *

On a scale of 1 to 10, how stressed you usually feel? (1 lower 10 higher) *

Do you have the time and commitment to transform your hair and your care habits? *

Yes, I am definitely committed

No, I don't have time

Goals & Commitment

Please feel free to elaborate on your answers as much as possible to obtain better information.

What is the biggest goal you would like to achieve in the next 6 months regarding your hair? and What is the biggest obstacle you are facing? *

What priority does this goal occupy in your life now? *

Is not important

Important

Very important

Among all the people who apply, why should we consider your application? If you enter our program, we expect genuine interest and commitment from you. We seek to integrate into our community people who can add value with their own experience in the same way that we are committed to adding value and achieving results. *

Our program GUARANTEES that you will begin to see the first results and achieve your goals in 3 months. Do you have at least 1,300 USD (dollars) to invest in transforming not only your hair but also your quality of life and achieving your goals with professional support? THIS IS NOT THE VALUE OF THE PROGRAM, it is the minimum you need to get started. *

Please review your form before sudmitting. If you can't submit, a requiared field may be missing.