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*
  • Few (0 - 20)
  • Slightly increased (20 - 40)
  • Increased (40 - 80)
  • Many (80 - 120)
  • Very many (more than 120)
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3. Which stage best reflects your hair loss?

Please select*
  • Stage 1: No thinning
  • Stage 2: Mild recession at temples
  • Stage 3: Thinning at crown or higher forehead
  • Stage 4: Visible balding on top
  • Stage 5: Advanced loss (sides/back only)
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4. Do you have dandruff?

5. How often do you wear hats or headgear?

6. Do you often feel stressed? 

Is it mainly due to:

7. Do men in your family have hair loss? 

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

Where did you hear about us?*
  • Search Engines (Google, Bing, Yahoo)
  • Social media - Facebook, Instagram, Tiktok
  • From a friend/family member
  • From another doctor
  • Email from us
  • Text message from us
  • Radio (incl. Podcast)
  • Other (please let us know)
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