What are your biggest hair concerns right now?

Select all that apply.

• Stop losing so much hair
• Make my hair grow faster
• Help my scalp, so everything else can work
• Restore shine and softness
• Deal with dryness or breakage

When you look in the mirror, what do you notice most about your hair?

• It looks thinner than it used to
• My scalp is more visible
• It feels limp and has no volume
• My hair looks dull and lifeless

How long have you been noticing these changes?

Be as honest as you can – this helps us understand how much support your scalp may need.

• Just started noticing (under 3 months)
• A few months (3–6 months)
• Over a year
• Several years

Have you tried products for your hair concerns before?

• Yes, but nothing has really worked
• Yes, some things helped a little, but not enough
• No, this is my first time looking for a solution

How does your scalp usually feel?

• Dry and tight
• Oily or greasy by midday
• Itchy or irritated
• Normal

How often do you wash your hair?

• Daily
• Every other day
• Twice a week or less

After you wash your hair, how long does the volume last?

This tells us a lot about what's happening beneath the surface of your scalp.

• It goes flat within hours
• Half a day at most
• It stays full for most of the day

How fast does your hair seem to grow?

• Very slowly
• Slower than it used to be
• At a normal pace

How much hair do you typically find on your brush or in the shower drain?

• A lot – it's hard to ignore
• More than I used to
• A normal amount, as always

How would you describe your hair texture?

• Straight
• Wavy
• Curly
• Coily

Have you had any of these done in the past year?

Select all that apply.

• Hair coloring or bleaching
• Keratin or chemical treatment
• Heat styling almost daily
• None of these

In the past 6 months, how would you describe your stress levels?

Stress has a direct impact on hair growth cycles, so it matters more than you'd think.

• High – I've been through a lot
• Moderate – the usual life stuff
• Low – I'm pretty balanced

How old are you?

This helps us understand where your hair's natural growth cycle is right now.

• Under 30
• 30 - 40
• 41 - 50
• 51 - 60
• 60+