HAIR LOSS TREATMENT TEST

Proven Hair Restoration & Hair Loss Treatment Solutions for Men & Women – Syracuse, New York

Hair Loss Tes for Men & Women
(315) 454-3132 —

Ready to take control of your hair loss? Get Answers Now!

You’re about to take the first step to restoring your hair! By taking this test, you’re headed in the right direction to feeling your best about your hair once again. Get started by answering the following questions.

    Name*

    Email*

    Address

    City, State, Zip

    Your Current Age

    At what age did you notice your hair was thinning?

    Does hair loss run in your family?
    YesNo

    How Long have you been experiencing hair loss?

    What is your area of most concern? Hairline/templesFrontal areaCrown (top)AllOther

    Are you presently taking prescription medication?
    YesNo

    Have you ever been diagnosed with Alopecia Areata?
    YesNo

    Have you been diagnosed with compulsive hair pulling?
    YesNo

    What hair loss treatments have you tried?
    Prescription MedicationHair ReplacementTransplantsWigs

    How would you describe your lifestyle?
    AverageActiveVery ActiveProfessional

    Please describe your current hair loss condition.

    How has hair loss affected you emotionally, if at all?

    Would you like to speak privately with an Profiles by Kristin hair loss specialist (no obligation)?
    YesNo

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