What’s your hair type?
Straight
Wavy
Curly
Coily
What is your current hair texture?
Drier than before
More brittle and breaks easily
Finer and more fragile
Stiffer, wirer that before
None of the above
All of the above
When did you first notice changes in your hair?
In the past 6 months
6-12 months ago
1-2 years ago
More than 2 years ago
There are no changes in thickness
What’s your biggest concern about your hair right now?
Overall thinning
Lack of volume
Slow or no growth
Breakage and damage
Hair loss
All of these
How much hair do you typically see in your brush or shower drain?
A few strands
A small handful
A concerning amount
So much it’s blocking my drain
I try not to look
Where do you notice the most hair loss?
Around the hairline
At the crown/top of head
Overall thinning
Temples/sides
I’m not sure yet
How visible is your scalp?
Only visible when hair is wet
Slightly visible in bright light
Noticeable when styling
Very visible and concerning
Not sure - I avoid looking closely
What solutions have you tried so far?
Different shampoos/conditioners
Vitamins/supplements
Prescription treatments
Hair fibers/concealers
All of the above
How would you rate the success of previous treatments?
No improvement
Slight improvement
Temporary improvement
Made it worse
What type of hair products do you currently use?
Regular drugstore brands
Salon professional products
Specialised hair loss products
Natural/organic products
How would you describe your scalp?
Normal
Dry and itchy
Oily
Sensitive/irritated
Not sure
What result would make the biggest difference for you?
More volume & thickness
Less shedding
Faster growth
Stronger, less breakage
All of the above
