Hair Loss Test
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Hair Loss Test

Ready to take control of your hair loss? Get Answers Now!

You’re about to take the first step to restoring your hair! By taking this quick test, you’re headed in the right direction to feeling your best about your hair once again. Get started by answering the following questions. Once you submit your responses, one of our Elite Hair Loss Specialists will contact you as soon as possible.

 

 

About Your Hair Loss

How would you describe your current degree of hair loss?
Please describe your current degree of hair loss.
Is your hair loss:
Please answer.
How long have you been experiencing hair loss?
Please answer how long you have been experiencing hair loss.
Which of the following are you currently experiencing? (select all that apply)
Please select which of the following you are currently experiencing.
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Do any of your "blood relatives" have hair loss or thinning hair?
Please answer if any of your relatives have hair loss or thinning hair.
Have you ever been diagnosed with a medical condition that could be related to your hair loss?
Please answer if you ever been diagnosed with a medical condition that could be related to your hair loss.
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Are you presently taking prescription medication?
Please answer if you are currently taking prescription medication.
Please explain.
Which part of your scalp is most concerning to you? (select all that apply)
Please answer which part of your scalp is most concerning to you.
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Please enter how hair loss has affected your life.
Have you tried or considered hair loss replacement options?
Please answer if you have tried or considered hair loss replacement options.
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I am interested in learning about: (select all that apply)
Please check what you are interested in.
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About You

Do you live within driving distance of Sacramento, California?
Please select if you live near Sacramento, California.
Which term best describes your gender identity?
Please select the term that best describes your gender identity. You can enter a custom term if preferred.
Please explain your gender.

Contact Information

Please enter your first name.
Please enter your last name.
Please enter your email address.
Please enter a valid phone number (123-456-7890).