GET HAIR MD™ HAIR QUIZ

1
What is your age?* This field is required.
2
Are you dealing with Male Patterned Baldness or Female Patterned Baldness?* This field is required.
Male
Female
3
How long have you been experiencing hair loss?* This field is required.
Less than 1 Year
1-3 Years
4-7 Years
Over 7 Years
4
Does anyone in your family suffer from hair loss?* This field is required.
YESNO
5
Have you tried anything to treat your hair loss?* This field is required.
YESNO
6
If you answered "Yes" to the last question: What hair loss treatments/products/procedures have you tried, and did they work for you?* This field is required.Simply write "N/A" if you answered "No" to the previous question.
7
Which number most clearly represents your current hair loss?Submit your answer on the next slide.
8
Which number most clearly represents your current hair loss?* This field is required.Press "Previous" to take another look at the 4 stages.
1
2
3
4
9
Finally, on a scale of 1-10, how important is it to you to stop your hair loss and regrow your hair?* This field is required.1 being not important at all, 10 being extremely important.
10
What is your name?* This field is required.
First Name
Last Name
11
What's your email?* This field is required.
example@example.com
12
What's your cell phone number?* This field is required.Our Get Hair MD team will first reach out via text.
Please enter a valid phone number.
13
What's your zipcode?* This field is required.So our Get Hair MD team can determine which one of our locations is nearest you.
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