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HairLoss Quiz India
Answer a few questions so that we can recommend the right solutions for your hair wellness needs
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1
Image Field
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2
What’s your name?
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First Name
Last Name
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3
Biological Gender?
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4
How many birthdays have you celebrated?
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18-24
25-34
35-45
46-60
60+
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5
Choose Image that best represents you
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Stage 1
Stage 2
Stage 2a
Stage 3a
Stage 3
Stage 3 vertex
Stage 4
Stage 4a
Stage 5
Stage 5a
Stage 6
Stage 7
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6
Choose Image that best represents you
*
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No Hair Loss
Temple & hair line thinning
Stage 1-I
Stage 1-II
Stage 1-III
Stage 2-I
Stage 2-II
Stage 2-III
Stage 3-I
Stage 3-II
Stage 3-III
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7
What are you hair wellness goals?
Growth
Thickness
Shine
Strength
Texture
Density
Volume
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8
Which of these apply to you?
Dandruff
Oily/Greasy
Hair shedding
Split ends
Heat or Color Damaged
Dry hair
Thinning, Loss of Volume
Dull, limp or lifeless hair
Frizzy Hair
Premature Graying
Other
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9
Which of these apply to you?
I sometimes experience stress/anxiety/restless sleep
I frequently experience stress/anxiety/restless sleep
I recently experienced or am undergoing a big life change - job, exams, relationship status, relocation, parenthood, loss of a loved one, moving, chemo, etc.)
My diet consists of a fair amount of refined carbs, sugary foods, processed foods, sweets, fried foods
I live or work in an area with less than optimal air and water quality
I tend to gain weight around my mid-section
I rarely eat refined carbs, processed foods, sugary foods, fried foods and mostly eat clean
I am a vegan/vegetarian
I am a non-vegetarian
Other
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10
Choose treatments undergone
Hair Transplant
Low Level Light Therapy
Finasteride Drug
Minoxidil Drug
PRP Hair Therapy
Vitamins/Supplements for Hair
MicroPigmentation (Tattooing the Scalp)
Hair Replacement Piece (Wig)
Therapeutic Shampoo/Conditioner/Serum/Oil etc
None of the above (I am doing headstands instead!)
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11
How much do you secretly care?
It's affecting my confidence
I'm worried
I'm aware of it
I don't care
I've given up
I'm being proactive
Other
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12
Email, so we can send you your results? We promise to not spam you.
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This field is required.
example@example.com
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13
Phone Number, so we can help get you a complimentary hair consultation.
Area Code
Phone Number
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14
Thanks! You did great. Hair loss can be really stressful. To help you out, we are offering a 30 min complimentary in-depth hair consultation. Book yours now!
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