Hair Loss Test | Graff Hair Technology

HAIR LOSS TEST

Ready to take control of your hair loss? Get Answers Now!

You’re about to take the first step to restoring your hair! By taking this test, you’re headed in the right direction to feeling your best about your hair once again. Get started by answering the following questions.
1. How would you describe your current degree of hair loss?

Early StagesModerateAdvanced
2. Is your hair loss:

Just StartingAcceleratingSlowing DownBasically DoneNot Sure
3. About how long have you been experience hair loss?
4. Are you currently experiencing:

Hair ShreddingThinningBreakageOily ScalpItchy/Dry/Flaky Scalp
5. Do any of your "blood relatives" have hair loss or thinning hair?

YesNo
6. Have you ever been diagnosed with a medical condition that could be related to your hair loss?

YesNoUnsure
7. Are you presently taking prescription medication?

YesNo
8. How has hair loss affected your life?
9. Have you tried or considered hair loss replacement options?

YesNo
10. What is your area of most concern?

Hairline/templesFrontal areaCrown (top)All
11. Are you interested in learning about: (check all that apply)

Free Private ConsultationNon-Surgical Hair RestorationScalp Therapy / Hair Loss PreventionHair ExtensionsProstheses / WigsToppersSkin Care / Anti-Aging TreatmentsHair Care Products
12. Do you live within driving distance of Riverside, California?

YesNo
Name*
Gender
Email*
Phone Number*
Should be Empty: