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1. What is your natural hair color?

Black

Dark Brown

Light Brown

Red-Haired

Dark Blonde

Light Blonde

Gray

White

2. What is your hair type?
3. What hair density do you have in the area where you are losing hair compared to the sides and back of your head?
4. Regarding the quality and thickness of the hair (donor zone) they are:
5. How long ago did your hair loss start?
6. How would you describe your hair loss?
7. What areas do you see hair loss?
8. What treatments for baldness have you used?
9. Are you currently using any of these treatments?
10. Which of the following images best describes your type of baldness?

2

2A

3

3A

3V

4

4A

5

5a

5v

6

7

10. Which of the following images best describes your type of baldness?

I-1

I-2

I-3

I-4

II-1

II-2

III

Avançado

Frontal

11. Is your hair loss related to menopause?
12. Have you ever had hormone tests?
11. What is your age range?
12. How did you find this site?

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