THE TESTING CENTER
Do you experience Symptomatic Cardiac issues or uncontrolled hypertension or uncontrolled symptomatic hypotension?
Yes
No
Thank you for filling out the questionaire - Please dont forget to email or text us your head shots - front, top, sides and back.
Current Age:
*
Have you been diagnosed with a skin disease (e.g., psoriasis, atopic dermatitis, skin cancer, eczema, sun damage, seborrheic dermatitis)?
No
Yes
Do you have a diagnosed history of autoimmune diseases?
No
Yes
Email:
*
Check here to receive email updates
Do you have a history of burning, flaking, itching, and stinging of the scalp?
No
Yes
Do you want to grow more hair?
Yes
No
Do you have a history, or have you had recent blood work indicating iron deficiency, bleeding disorders or platelet dysfunction syndrome or are you receiving anticoagulant therapy?
Yes
No
Phone
*
I will send my head shot of my areas of concern.
Yes -
NO - I am not interested in taking the first step to grow my hair back.
Have you experienced scalp hair loss due to disease, injury, or medical therapy?
Yes
No
Have you recently used low-level lasers for hair growth?
Yes
No
Have you been clinically diagnosed with having alopecia areata or scarring forms of alopecia?
Yes
No
Are you currently undergoing chemotherapy or radiation treatments?
Yes
No
.
Home
About
Study Registration
Contact
Questions
Questions 2
Question 3
Do you have a history of surgical correction of hair loss on the scalp (i.e hair transplant)
Yes
No
Name:
*
Have you been diagnosed to have any of the listed thyroid autoimmune conditions?
Hashimoto thyroiditis.
Painless thyroiditis.
Postpartum thyroiditis.
Subacute thyroiditis.
Graves' disease
No
View on Mobile