1. What is your age?

2. How many hairs do you think you shed each day?

You can estimate this by checking your pillow in the morning, combing your hair over a sink and counting loose hairs, then repeating in the evening. Add these up for your daily total.

Please select*

3. Which stage best reflects your hair loss?

Please select*

4. Do you have dandruff?

Yes

No

5. How often do you wear hats or headgear?

Often

Sometimes

Never

6. Do you often feel stressed?

No

Yes

Is it mainly due to:

Time pressure

Physical strain

Performance pressure (work, exams, etc.)

7. Do men in your family have hair loss?

No

Father’s side

Mother’s side

Both sides

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

Where did you hear about us?*