1. How old are you?

2. Are you experiencing thinning?

Yes

No

3. Approximately how many hairs are you losing on a daily basis?

4. How advanced is your hair loss?

hair loss stages

Stage 1: Full hair

Stage 2: Hairline starting to recede

Stage 3: Hairline has receded and early signs of thinning on top of the head and crown (monk's tonsure)

Stage 4: Obvious baldness on the top of the head

Stage 5: Your hairline recession connects to the bald spot on your crown

5. What’s your diet habit?

I eat a lot of processed foods

I eat healthy most of the time

I eat a well balanced diet

6. Do you suffer from stress?

Yes

No

7. Do you have trouble sleeping?

Yes

No

8. What is the history of hair loss in your family

I am not aware of any hair loss in my family

None of my relatives suffered from hair loss

Relatives on my father's side suffered from hair loss

Relatives on my mother's side suffered from hair loss

Relatives both on my mother’s and my father’s side suffered from hair loss

9. Please leave your contact information below so we can send you the quiz results

You can call me to discuss my results and possible solutions