Hair Health Check: DISCOVER WHY YOU MAY BE LOSING YOUR HAIR.

Welcome to your Hair Loss Assessment

After your assessment is completed one of our senior consultants will take a look at your results and report back to you.

What is your gender?

Male

Female

What best describes your hair loss?

Receding hairline

Thinning at the crown

General thinning all over

Patchy hair loss

losing hair in bunches

Medical history

Yes, I have had covid

Yes, I have been hospitalized recently

Yes, I have recently had surgery under general anaesthetic

Yes, I am on chronic medication

None of the Above

How long have you been experiencing hair loss?

Less than 6 months

6 months to 1 year

1-2 years

More than 2 years

Do you have a family history of hair loss?

Yes

No

Not sure

How would you describe your stress levels?

Low

Moderate

High

Extremely high

Are you experiencing any other symptoms?

Scalp irritation or dandruff

Rapid weight changes

Hot flushes

Pain on the scalp

None of the above

1 out of 3

What is your age range?

Under 25

25-35

35-45

Over 45

How would you describe your diet?

Balanced and nutritious

Average with some junk food

Mostly unhealthy

Varies a lot

Are you using any hair treatments or medications now?

Yes

No

2 out of 3

Would you consider a DNA swab test to determine your genetic hair loss profile?

Yes

No

3 out of 3

You have one more step to go.

Once your information has been submitted, one of our Senior Consultants will take a look and contact you either Via Phone Call, or WhatsApp message.

Name & Surname

Province

Email Address

Phone Number

How would you like to be contacted?