Chemical Relaxers and Synthetic Hair Exposure | Violet Sheet | Fillable and Printable PDF

Because your hair history is part of your health history.

This printable Violet Sheet package is designed to help women document chemical relaxer and synthetic hair exposure for their medical records. Research is raising real questions about chemical relaxers, synthetic hair, and reproductive health — and most doctors never ask about hair product history.

In appointments where this connection is rarely raised, this guided tool helps you document your exposure clearly and get it into your chart.

Built using the Rooted in Violet ROOT Framework, this resource is especially designed to support Black women and women of color navigating reproductive health conversations that rarely include hair product exposure.

Inside this printable toolkit: ✔ exposure history worksheet (years of use, frequency, brands, scalp irritation) ✔ symptom tracker (cycle changes, pelvic symptoms) ✔ family history prompts ✔ script to request documentation and evaluation ✔ printable PDF instant download

Perfect for:

women who have used chemical relaxers or synthetic hair long-term

women concerned about reproductive health connections

Black women advocating for thorough medical documentation

anyone wanting their full exposure history in their medical chart

women preparing for a reproductive health appointment

What this toolkit helps with This package helps you:

document years of use, frequency, brands, and irritation

connect exposure to symptoms worth flagging to your provider

request that your exposure history be documented and evaluated

ensure it becomes part of your permanent medical record

Created by Rooted in Violet & Co., this Violet Sheet is designed to support women in getting overlooked exposure history the attention it deserves.

Format Printable PDF · Instant digital download · Guided advocacy sheet

Important Disclaimer This resource is for educational and self-advocacy purposes only and is not medical advice. Always consult your healthcare provider regarding your specific health concerns.

Refund Policy Due to the digital nature of this product, all sales are final and non-refundable. Please read the full description before purchasing. If you have trouble accessing your file, contact us within 7 days so we can help resolve the issue.