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Does your hair ever break at the ends?
Yes
No
Do you find that your shower drain is clogged with hair?
Yes
No
Do you lose hair when you shampoo your hair?
Yes
No
Do you often have to use styling products or heat to control your hair?
Yes
No
Are you worried about thinning hair?
Yes
No
On a scale of 1-10 how worried are you about hair loss?
😄
Yay!
WTF!!
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Do you have split ends?
Yes
No
Do you have difficulty growing your hair?
Yes
No
Have you tried supplements for hair growth in the past?
Yes
No
Do you suffer from any of the following:
Hair Loss
Oily Hair
Dry Hair
Thinning Hair
Dry Itchy Scalp
Dandruff
Sensitive Scalp
Brittle Hair
Easily Tangled Hair
Receding Hairline
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Does your hair lack volume?
Yes
No
Is your hair fine or thick?
Fine
In the middle
Thick
Do you color or use chemical treatments on your hair?
Yes
No
Do you use any of the following heat styling tools daily?
Flat Iron
Hair Dryer
Curling Iron
I don't use any of these
How often do you wash your hair?
Daily
A few times a week
Weekly
As infrequently as possible
Are you taking multivitamins?
Yes
No
Do you eat packaged foods regularly?
1-3 times per week
4-6 times per week
More than 6 times per week
Never
Do you feel bloated after meals?
Yes
No
Are you suffering from any of the following:
Menopause
PCOS
Peri-menopause
None
Do you have a known vitamin or mineral deficiency?
Yes
No
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