Hair loss profile and questionnaire for female and male pattern baldness

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How you can determine if you have a problem with your hair, and the steps you can take to understand your specific hair loss problem. Already a hari guru - take Samson's hair loss quiz.

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1. What is your Gender?

2. What is your Age?

3. Do you currently have any chemical treatment in your hair?

4. Is you hair thinning?
Yes
No

5. Do you experience breakage while shampooing, brushing or combing your hair?

6. Are you experiencing split-ends?
Yes
No

7. Are you experiencing patterned baldness?
Yes
No

8. Do you believe your hair loss or baldness is hereditary?
Yes
No

9. Do you believe your hair loss or baldness comes from your father's side of your family?
Yes
No

10. Do you believe your hair loss or baldness comes from your mother's side of your family?
Yes
No

11. Do you see a hair care professional/ hair stylist?

12. Do you manage your hair care yourself?
Yes
No

13. What condition do you believe your hair is in?

14. Do you have bald spots?
Yes
No

15. Have you been diagnosed with Alopecia?
Yes
No

16. Do you currently take medication?

17. Are you a vegetarian?
Yes
No

18. Do you eat a well balanced diet 3 time a day?
Yes
No

19. Do you take vitamins daily?
Yes
No

20. Do you take herbs/supplements daily?
Yes
No

21. Would you like a free consultation?
Yes
No

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