Welcome to your Hair Consultation!
Share your hair story with us. We're here to get to know you, so that our team of hair and health research doctors can create your all-in-one Hair Hub dashboard that does just what your hair needs.
This 10-minute consultation gives our team the complete picture they need to build your personalized, all-in-one Hair Hub dashboard.
/39
What is your primary hair concern?
Hair Loss (general)
Thinning Hair
Dandruff
Itchy Scalp
Diagnosed Alopecia (areata, androgenic etc.)
Telogen Effluvium
Postpartum Hair Loss
Seborrheic Dermatitis
Other:
/39
How long have you been experiencing this hair concern?
Less than 3 months
3-6 months
6-12 months
1-3 years
More than 3 years
/39
Has your hair shedding/loss been:
Episodic (comes and goes)
Continuous
Unsure
/39
Estimate the percentage of hair lost overall:
0–10%
10–25%
25–50%
50–75%
75–100%
/39
Where are your problem areas? (select all that apply)
Hairline/Edges
Back of my scalp
Middle of my scalp
All over
/39
How sensitive is your scalp?
Not sensitive at all, I never have problems with products
Usually fine, but it can be sensitive to acids or active ingredients
Regularly quite sensitive to a lot of products
Very sensitive skin, most products irritate my scalp
/39
On a scale of 1-7, how much does this hair concern impact your daily life?
1
2
3
4
5
6
7
/39
Please select any current medical conditions you have:
None
Thyroid disorder (Hypothyroidism/Hyperthyroidism)
PCOS (Polycystic Ovary Syndrome)
Uterine Fibroids
Diabetes
Autoimmune disease
Nutritional deficiencies
Hormonal Imbalances
Chronic Stress or Anxiety
Other:
/39
Have you had any of the following in the past 6 months? (select all that apply)
Major surgery
Fever or illness
Childbirth or pregnancy
Significant emotional/mental distress
New medications or supplements
None of the above
Other:
/39
Do you have a family history of the following? (select all that apply)
Alopecia areata (AnA)
Androgenic Alopecia (AA)
Autoimmune disease
Thyroid disorder
None of the above
Unsure
/39
Are you using any of the following for your condition? (select all that apply)
Topical prescriptions
Oral prescriptions
Supplements
Herbal remedies/treatments
None of the above
/39
Please list any medications you’re currently taking (including prescriptions, herbal medicine, and supplements):
/39
What else, if anything, have you tried to resolve your condition? (for e.g., medical intervention, dermatologist, trichologist, etc.)
/39
Are you currently:
Menstruating
Perimenopausal
Menopausal/Postmenopausal
Pregnant
Breastfeeding
TTC (Trying to Conceive)
None of the above
/39
How would you describe your menstrual cycle? (if applicable)
Regular
Irregular
Painful or symptomatic (cramps, fatigue, etc.)
I no longer menstruate
Not applicable
/39
Which of the following are part of your regular diet? (select all that apply)
I eat meat
I eat fish
I eat vegetables
I eat fruits
I eat grains/legumes
I eat dairy
I eat gluten
I eat processed sugar
I eat pre-packaged foods
I eat fast food
I drink alcohol
I drink pop/soda
/39
Do you have a particular love (or weakness) for any of these? (select all that apply)
None of these
Caffeine
Nicotine or tobacco
Marijuana
Vaping
/39
Have you recently changed your diet or supplements?
Yes
No
/39
Describe your current supplement routine (brands, frequency, doses if known):
/39
How would you describe your average daily stress levels?
Very Relaxed
Somewhat Relaxed
Somewhat Stressed
Very Stressed
/39
How satisfied are you with your daily nutrition?
Very Satisfied
Satisfied
Unsatisfied
Very Unsatisfied
/39
How active are you on a daily basis?
Very Active
Active
Inactive
Very Inactive
/39
Average weekly activity level (hours per week):
/39
How would you rate your average daily sleep quality?
Excellent
Good
Poor
Very Poor
/39
Average sleep duration (hours per night):
/39
Do you suspect any of the following may have triggered your hair issues? (select all that apply)
Diet or weight changes
Stress or emotional trauma
Illness or Infection
Medication
Hormonal shifts
Hair product or chemical use
Mold exposure
Heavy metal exposure
None of the above
Other:
/39
If you indicated a trigger above, when did the trigger occur in relation to your hair issue?
/39
How often do you wash your hair?
Weekly
Multiple times a week
Bi-weekly
Monthly
Quarterly
Other:
/39
What styling methods do you regularly use? (e.g., braids, wigs, heat tools)
/39
Do you color or chemically treat your hair?
Yes
No
Occasionally
/39
What brands/products are currently part of your routine?
/39
How much do you currently invest in maintaining your hair health and styling per year? (Include salon visits, products, treatments, etc.)
Under $500/year (less than $42/month)
$500 - $1,200/year ($42-$100/month)
$1,200 - $2,400/year ($100-$200/month)
$2,400 - $4,800/year ($200-$400/month)
Over $4,800/year (more than $400/month)
/39
Now for your details, what is your full name?
/39
What is your email
Please enter a valid email format
/39
What gender were you assigned at birth?
Male
Female
/39
What is your ideal body weight in pounds?
/39
What is your phone number?
/39
What is your date of birth?
/39
What are your top 1–2 goals for your hair and health over the next 3 months?
Congratulations, You're one step closer! Thank you for your thoughtful responses.