Share your hair loss story
Would you like to be part of highlighting voices and creating awareness about hair loss?
A lot goes unsaid about hair loss, so let’s change that. We want to open the conversation to those affected by hair loss. If you want to be part of the cause, please complete the survey below.
While completing this survey, you can be anonymous or submit your name and photo. This is completely up to you and your comfort level, as your story may be featured on our website, social media platforms, and promotional content. We will reach out with more information and consent forms if we choose to feature your story. Feel free to answer as many questions as you want or create your own prompt.
Name (optional)
First Name
Last Name
Email (this will not be shared)
example@example.com
Submit a photo of yourself to accompany your answer that may be shared on our website, social media platforms, and promotional content (optional)
Browse Files
Drag and drop files here
Choose a file
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of
Gender identity
*
Female
Male
Gender non-conforming
Prefer not to say
What are your pronouns?
Age
City
State
Country
Which medical condition do you associate with your hair loss?
How long have you been experiencing hair loss?
What was the first thing you did when you discovered signs of hair loss? How did you feel? (Optional)
Please share your hair loss story, and don’t hold back. You can share your experience finding your first spot/shedding, your reactions to the diagnosis, the emotions you felt/feel, how you’re doing now, and/or anything else you feel comfortable sharing (optional).
What's a lesson you learned from facing challenges with hair loss? (Optional)
Describe an unexpected way hair loss has positively impacted your life (optional).
What aspect of hair loss do you believe needs more awareness, and why? (Optional)
How do you handle the emotional challenges of hair loss? (Optional)
What’s a misconception about hair loss you’d like to correct? (Optional)
What’s something hair loss has taught you about self-acceptance? (Optional)
If there was one thing you could tell someone about hair loss, what would it be? (Optional)
Give a piece of advice for someone with hair loss who is in hiding (optional).
Give a piece of advice to anyone with hair loss (optional).
Create your own prompt (optional).
Submit
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