What type of hair issue are you experiencing?

Overall thinning

Bald spots or patchy loss

Receding hairline

Sudden or rapid hair loss

Seasonal or stress-related shedding

No active loss, just prevention

How long have you been experiencing this issue?

Less than 6 months

6-12 Months

1-3 Years

Over 3 Years

What treatments have you tried so far?

What’s your overall goal with treatment?

Regrow hair in visibly thin areas

Prevent further loss

Improve volume/density slightly

Just learning about my options

What are you hoping for?

How quickly has your hair changed? - How would you describe the pace of loss?

Rapid — big change in months

Gradual over 1–3 years

Very slow, almost unnoticeable

Can’t tell

Have you been told the cause of your hair loss?

Yes — it’s genetic or hormonal

Yes — stress or medical condition

Not officially diagnosed

No idea

Are you open to regenerative or non-surgical options?

Yes — If it will work for me.

Possibly — I need more information

I'm not sure

Family History - Does hair loss run in your family?

Yes — one or both parents

Some — maybe one side

No known history

Have you experienced any major health changes recently?

Yes — illness, surgery, or hormonal shifts

Some changes — but nothing major

No, things have been consistent

Have you experienced any major health changes recently?

How would you describe your scalp?

Healthy – no irritation or buildup

Occasionally itchy or flaky

Oily, sensitive, or reactive

Unsure

Is your main concern hair density or shedding?

Loss of volume/density

Ongoing shedding

Both

Not sure

Age of Onset- When did you first start noticing changes?

Under 25

25-35

35-45

After 45

Do you follow a consistent hair care routine?

Yes — specific products, scalp care

Somewhat — but nothing consistent

Not really

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