Hair Care Survey

Full Name *

Age Group *

Gender *

Location / Region *

How would you describe your daily water intake? *

How balanced is your diet? *

Do you consume biotin, multivitamins, or hair supplements? *

Do you smoke or consume alcohol? *

Are you currently facing high levels of stress or anxiety? *

What is your hair type? *

Hair texture: *

What is your scalp type? *

What are your current hair concerns? *

How often do you experience hair fall? *

How many strands do you think you lose per day? *

How long has the hair fall/hair issue been happening? *

How often do you wash your hair? *

What products do you regularly use? (Select all that apply) *

Do you oil your hair? *

Have you had any of the following treatments in the past 6 months? *

Do you have any known medical conditions affecting hair health? (e.g., PCOS, thyroid, anemia) *

Are you on any medication that may affect your hair? *

Have you recently experienced childbirth or hormonal changes? *

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