Discover Your Hair’s Health with a Quick & Easy Test!
Test Your Hair Health
Before we start can we get your name?
*
Email
*
Phone Number
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How Old Are You
*
Gender
Male
Female
Which image best describes your hair loss?
Stage - 1
Stage - 2
Stage - 3
Stage - 4
Stage - 5
Stage - 6
Coin Size Patch
Heavy Hair Fall
Do you have a family history of hair loss?
Mother or anyone from mothers side of the family
Father or anyone from fathers side of the family
Both
None
Have you experienced any of the below in the last 1 year?
None
, severe health issues (Dengue, Malaria, Typhoid or Covid)
Heavy weight loss / Heavy weight gain
Surgery / Heavy medication
Do you have dandruff?
No
Yes, Mild that Comes and Goes
Yes, Heavy Dandruff that Sticks to the Scalp
I have psoriasis – A skin condition that causes red, dry, patches on your scalp
I have seborrheic dermatitis – a condition making your scalp itchy, red with a burning feeling
How well do you sleep?
Very peacefully for 6 to 8 hours
Disturbed sleep, I wake up at least one time during the night
Have difficulty falling a sleep
How stressed are you?
None
Low
Moderate (work, family, etc)
High (loss of close one, separation , home, illness)
Are you currently dealing with any of these health conditions?
None
Anemia(low iron / haemoglobin)
Asthma
Sinus problems
Do you feel constipated?
No/rarely
Yes, unsatisfactory bowel movements
Suffering from IBS(irritable bowel syndrome ) / dysentery
Do you have Gas ,Acidity or Bloating?
Yes
No
How are your energy levels?
Always High
Low when I wake up but gradually increases
Very Low in Afternoon
Low by Evening / Night
Always Low
Are you currently taking any supplements or vitamins for hair?
Yes
No
Not Sure
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