Take The Hair Loss Quiz

1

What is your gender?* This field is required.

Male

Female

Non-Binary

2

What is your age range?* This field is required.

18 to 35

36 to 50

51 to 65

66+

3

When did you start noticing your hair loss?* This field is required.

Within the last 60 days

Within the last year

More than 12 months ago

6

Do you have any relatives who are suffering from hair loss?* This field is required.

Yes

No

7

Have you recently experienced a particularly stressful event?* This field is required.

YESNO

8

Have you been diagnosed by a physician as having Androgenetic alopecia/Pattern Hair Loss?* This field is required.

YESNO

9

Are you currently treating your hair loss with any of the following?* This field is required.Check all that apply

Minoxidil

Special shampoos

Vitamins and/or supplements

I am not using anything to treat my hair loss

10

What is your name?* This field is required.

11

What is your email?* This field is required.So we can send you your results

12

Please provide your phone number(Optional)