1. What is your primary scalp and hair concern?
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Scalp psoriasis, dermatitis, or folliculitis
Dryness, flaking, or persistent itchiness
Tenderness, redness, or sensitive inflammation
Hair thinning or excessive shedding and breakage
2. How would you describe the overall thickness and density of your hair?
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Naturally fine or thin, and easily weighed down
Medium texture, but noticeable thinning around the part or hairline
Thick, but experiencing sudden shedding or breakage
Experiencing gradual volume loss all over
3. What environmental or lifestyle factor impacts your hair the most?
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Frequent heat styling or chemical treatments
Stress, dietary changes, or hormonal shifts
Hard water, product buildup, or frequent sweating
Seasonal weather changes (excessive dry heat or humidity)
4. How often do you feel the need to wash your hair to keep your scalp comfortable?
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Daily (it feels oily or dirty very quickly)
Every 2–3 days (a balanced routine)
Once a week or less (to avoid stripping moisture)
It varies because my scalp constantly feels unbalanced
5. Are you currently using a shampoo powered by these key botanical and targeted ingredients? Key Vitamins & Nutrients: Vitamin H (Biotin), Vitamin B6, Vitamin B3 (Niacinamide), Vitamin B5 (Panthenol), Vitamin A, Vitamin ETargeted Growth & DHT Blockers: Saw Palmetto, Pumpkin Seed Oil, Horsetail, Nettles, Green Tea, Natural DHT BlockersScalp Soothing & Herbal Actives: Rosemary Oil, Yucca Root Extract, Chamomile, Lavender, Aloe Vera, Peppermint, Tea Tree Oi
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Yes, my shampoo already contains these exact ingredients!
No, but I am looking for a formula that includes them to restore my hair and scalp health.
I'm not sure—I need to check my bottle label!
First Name
Last Name
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Mobile Number
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-
Area Code
Phone Number
Email
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example@example.com
Atlanta Hair Doctor Team Member will call you back!
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