What is your gender?
Female
Male
How old are you?
1) How long have you been experiencing hair loss?
Less than 1 year
More than 1 year
2) Do the back and sides of your scalp have full, healthy hair?
No
Yes
3) Do you have family members with similar patterns of hair loss?
No
Yes
4) Have you ever used hair restoration products before, such as Rogaine, Propecia or another product?
Yes
No
5) Do you currently use a hair system? (wigs, toupees, weaves, braids, etc)
Yes
No
6) Is your hair longer than 1/4 in.?
Yes
No
7) Are you currently using any special medications, or have you recently been under a lot of stress?
Yes
No
8) Of these images, which one is closest to your level of hair loss?
9) On a scale of 1-5, how comfortable do you feel getting hair restoration surgery? (1 being "Not comfortable, 5 being "Very comfortable")