Hair Quiz Time!

We want to better understand YOUR unique hair loss situation.

Are you expierencing Male or Female Patterned Baldness? *

Male
Female
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Where Are You Noticing Hair Loss? *

Along The Hairline

General Thinning

At The Crown

All Over

Where Are You Noticing Hair Loss? *

General Thinning

Top of My Head

Along My Part

All Over

How Much Hair Have You Lost? *

A Little (Only I notice it)

Some (Those close to me notice it)

A Lot (It's obvious to everyone)

How long have you been experiencing hair loss? *

Less Than 1 Year
1 - 3 Years
4 - 7 Years
Over 7 Years
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What Solutions Have You Tried To Treat Hair Loss? *

Shampoos & Conditioners

Serums

Oral Medication

Medical Procedures

Other

None

The Standard Questions

Thank you! Now we need a few contact details so we can reach out to discuss your Hair Quiz answers!

First Name *

Last Name *

Date of Birth *

Phone *

Email *

Postal code *

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