2. Email Address

We need this to send your PDF report and to process your profile.

3. Mobile Number

4. Age

5. Gender

6. How would you rate your stress levels over the past few weeks?

7. Which of the following best describes your current hair condition?

8. Have you noticed dandruff or scalp flaking?

9. Do you currently take any supplements or vitamins specifically for your hair?

10. Which area of your scalp is most affected?

11. How would you describe your sleep pattern?

12. Do your close family members have a history of hair loss?

13. How would you describe your energy levels during a typical day?

14. Do you frequently experience digestive discomfort?

15. Do you experience constipation or irregular bowel movements?

16. Have you ever been diagnosed with a blood pressure condition?

17. Which statement best describes your eating habits?

18. Which digestive symptoms do you experience most?

19. Have you had any recent illness, surgery, or high fever?

20. Have you experienced sudden weight loss or gain in the last 6 months?

6. Which image best represents your current hair density?

7. Approximately how much hair do you lose during washing/brushing?

8. How long have you been noticing excessive hair fall?

9. Which image most closely matches your scalp or hair partition?

10. Have you undergone any of the following hair procedures recently?

11. Which statement best describes your scalp condition?

12. Has anyone in your immediate family experienced hair loss?

13. How would you describe your sleep quality?

14. How would you rate your stress level recently?

15. Which option best describes your daily energy levels?

16. Which statement best describes your eating habits?

17. Have you experienced any digestive issues recently?

18. Have you ever been told that your iron levels are low?

19. Are you currently taking any vitamins or nutritional supplements?

20. Do you have a blood pressure condition?

21. Are you currently in any of the following stages?

22. Have you experienced any hormone-related symptoms?

23. Have you had any recent illness, surgery, or high fever?

24. Have you experienced sudden weight loss or gain in the last 6 months?

25. How would you describe your bowel movements?

Upload a clear photo of your scalp

A photograph allows our specialists to better understand your hair condition.