Hair Loss Assessment

9 Out of 10 People
Who Take This Hair Loss Assessment

Find The Solution To Their Hair Loss!

Are you male or female? *MaleFemale

How old are you? *Younger than 21 years oldBetween 21 and 45 years oldBetween 45 and 55 years oldOlder than 55 years old

How long have you been losing hair or thinning? *Less than one yearBetween two and five yearsBetween five and ten yearsMore than ten years

Does anyone else in your family suffer from hair loss or thinning hair? *YesNo

Do you have any medical conditions that require you to be under a doctors care? *YesNo

Have you had any weight loss or weight gains of 10 pounds or more in the past 12 months? *YesNo

How would you rate your stress levels? *AverageAbove averageVery highSevere

Have you suffered any life altering events that can be classified as “traumatic” in the past 5 years? *YesNo

First Name *

Last Name *

Email Address *

Phone *

Please describe your hair loss issue *

Please indicate your preferred next step by selecting one of the following options: *I would like to be contacted by a Hair Loss Specialist promptly to discuss my assessment / hair loss issue and potentially arrange a consultation.I'm choosing to wait on addressing my hair loss, despite the risk of further thinning.

Best time to contact me:Morning 8am-12pmAfternoon 12-4pmEvening 4-7pm

Disclaimer *

This is a general and preliminary assessment. An In-person Consultation and Scalp examination is necessary for a full treatment recommendation. I agree with the privacy policy and terms and conditions.

Please do not fill in this field.

Hair Loss Assessment

9 Out of 10 People Who Take This Hair Loss Assessment

Find The Solution To Their Hair Loss!

9 Out of 10 People
Who Take This Hair Loss Assessment