Quiz - Advanced Hair Direct

What is your sex at birth?

Hair loss affects men and women differently biologically, with unique causes and treatments for each. Treatment is prescribed based on birth sex, not gender identity.

What is your date of birth?

You have to be over 18 to be eligible for this treatment.

Just a few more bits of info

We’ll need this information to send you your treatment. We’ll also use this information to connect you to a practitioner at your nearest Advanced Hair Clinic.

What's your phone number

Awesome, now let's talk...

Time to get personal

These answers are confidential and will be between you and your doctor.

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

Yes No

Do you have any allergies?

Yes No

Do you have any medical conditions?

Yes No

Are you breastfeeding, pregnant, or planning to conceive in the next 6 months?

Yes No

Have you had any heart problems or have you ever had a stroke?

Yes No

How would you describe your current hair stage?

How would you currently describe your hair stage?

Show us a recent photo

This will only be shown to your practitioner so they can assess and tailor your treatment for you.

HINT: If you're using a desktop computer, you might find it easier to take the photos on your mobile device first and then transfer them to your computer for uploading.

Choose a file jpg, gif, png or pdf formats up to 20MB

Thanks for sharing, we’ll find the right treatment for you.

How long has it been bothering you, how do you feel?

Hasn’t bothered me yet, but it’s better to be ahead of a potential problem I’ve just started to notice, and I’m starting to feel self-conscious For the last 6 months I’ve really been able to notice changes It’s been thinning/falling out for longer than I care to remember It’s been years and I’m starting to feel like I need to make a change I have sudden onset hair loss

We're almost done.

What are your hair goals?

Regrow my hair, regain my confidence Prevent further hair loss and maintain what I have Regrowth and prevention for the long term

Tell us your full, legal name

What is your sex at birth?

What is your date of birth?

Just a few more bits of info

Time to get personal

How would you describe your current hair stage?

Show us a recent photo

How long has it been bothering you, how do you feel?

What are your hair goals?

Thanks for telling us!

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