Hair Loss Quiz

STARTING YOUR HAIR LOSS CONSULT

This is where it all starts. A few simple questions you’ll answer and you’re on your way. Rest assured, everything is totally confidential.

By clicking NEXT, you agree to our Privacy Policy , Terms & Conditions and Collection Notice.

Please note: this quiz will take approximately 2 minutes to complete.

What is your birth sex?

Male Female

Date of Birth?

Which of these statements best represents the current status of your hair?

No hair loss Mild receding Medium receding Thinning on crown Thinning + receding No hair on top

How can AdvancedHairDirect help you?

Regrow my hair Prevent further hair loss Regrowth and prevention

How long has your hair been bothering you?

It hasn’t thus far, but better to be ahead of a potential problem Recently For around 6-12 months It’s been thinning/falling out for quite a while, longer than I care to remember I have patches of hair loss I have sudden onset hair loss (really noticeable recently)

Please upload photos of hair

Are you taking any medication, Including prescription or non-prescription medication such as vitamins & supplements?

Please specify

Do you have any allergies?

Please provide your contact information so our hair loss consultant can contact you.

First Name

Last Name

Email Address

Phone

We'll be asking a few questions about your hair, so doctors can find the best treatment for you. This quiz is short and sweet and your answers are secure and confidential between you and your Dr.

Est. time to complete: 2 minutes

By clicking 'Next' you agree to our terms & conditions and privacy policy and consent to telehealth.

Which options best illustrates your pattern of hair loss?

No hair loss Mild receding Medium receding Thinning on crown Thinning + receding No hair on top

What results are you looking for?

Regrow my hair Prevent further hair loss Regrowth and prevention

Is there hair loss in the family?

Yes No

When did you first notice hair loss?

I haven't, I'm in prevention mode Only recently It's been gradually happening for years It's been falling out in patches I've lost 50%+ in the last three months

How much body hair do you have?

1 (not hairy) 2 3 4 5 (very hairy)

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Hair Loss Quiz

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