To help us establish whether you are suffering from male pattern hair loss we need to ask you a few questions. The good news is it will only take you a couple minutes and at the end of the questionnaire we will share with you what we think is the most effective treatment for your stage of hair loss.

So let's get started.

What's your email?

Hair Loss

The following questions will help us establish your stage of hair loss and also confirm that your hair loss is genetic in nature

What Pattern/Stage of hair loss do you have?

Other

When did you first notice you were losing your hair?

Less than 1 year
Between 1 and 2 years
Between 2 and 5 years
5 years or more

Was the hair loss sudden or gradual?

Gradual
Sudden

Have you experienced hair loss on your face or body?

No
Yes

Is there a history of hair loss in your family?

Yes (can be father, mother, granparents, uncle, brother, sister, etc)
No relatives with hair loss
Not sure

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