Men's Hair Recommendation Form

Your Name* This field is required.First & Last Name

First Name

Last Name

Phone Number* This field is required.Best Contact Number

Area Code

Phone Number

E-mail* This field is required.For Order Updates, Invoices, & Shipment Information

What is your ethnicity?

Caucasian

Asian

Indian

African American

Latin

Other

Which age group do you fall under?We ask this question to help us understand things that might affect your hair system. It helps us if we know things like hair density and recession.

18 or Younger

18-30

31-40

41-50

51-60

Older than 60

What best describes your situation?We ask this question to help us understand things that might affect your hair system. It helps us if we know things like hair density and recession.

I currently wear a hair system

I used to wear one, but not anymore

I have never worn a hair system

Have you tried other hair loss solutions in the past?We ask this question to help us understand things that might affect your hair system. It helps us if we know things like hair density and recession.

Propecia

Rogaine

Topical Fibers

Laser Therapy

Extensions/Weaves

Herbal Supplements

Transplant/Surgery

None

Other

What type of hair loss do you have?Select the image that most closely represents your hair loss situation

How often do you sweat profusely?

Daily (Labor intensive work, Work outs at the gym, or have active sweat pores)

Few days per week (Hit the gym a few days out of the week)

A couple of times a month (No gym and not too active)

Never (Not active and never really breaks a sweat)

The environment that you spend the most time at is usually?

Mostly Dry

Mostly Humid

Average Conditions

How oily is your skin?

Dry

Average

Oily

How often would you like to remove/reattach your hair system?

Daily

Every few days

Weekly

Every 2 weeks

Every 3 to 4 weeks

I'm not sure

Which attachment method do you prefer?

Liquid Adhesives

Tape

Clips

Combination

Not Sure

What features do you expect from a hair system?

Appearance

Appearance & Durability

Longevity & Value

Which front hairline do you want?

Describe your hair color

Which hair color option would best represent your own

Black

Light Brown

Dark Brown

Red

Blonde

Gray or Not Gray

Select a style you would wish to achieve

Take and submit your own photos

Upload a photo of yourselfTry to provide photos from all angles. The more images the better.

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Upload an image of the hairstyle you would like to achieve

Drag and drop files here

Select files to upload

Max. file size: 10.6MB

Thank you for completing the questionnaire. The next step is to schedule your consultation with one of our experts.

Men's Hair Recommendation Form