How much hairfall do you experience while combing or washing your hair?
How long have you been experiencing increased hairfall?
Less than 6 months 6 months to 2 year 2 year to 5 years More than 5 years Not Applicable
Select ONE image that shows your current scalp condition
Choose the closest match. These illustrations are for general information and are not diagnostic.
What hair treatments have you done in the past 2 years?
Select at least one option
How is your dandruff these days?
Is hair loss a genetic issue in your family?
Yes, my mother or mother's side of family Yes, my father or father's side of family Both sides of the family No, not a genetic issue
How have your iron levels been historically?
Low Normal Not sure
Which of these do you tend to experience?
Select at least one option
None Pimples on chin or lower face Extra hair on face Irregular periods Other hormonal problems
Are you going through any of these life stages currently?
None Planning to get Pregnant sometime soon Currently Pregnant My baby is less than 1 year old or I am breastfeeding I don’t get my periods anymore
Which of these best describe your stomach/digestion issues these days?
Select at least one option
No issues Acidity or gas or stomach feels heavy Mostly Constipatedkabz - pet saaf na hona Loose motions Serious stomach or digestion problems
How well do you sleep these days?
6–8 hrs, peaceful sleep 6+ hrs but disturbed Less than 6 hrs, highly irregular
How would you describe your stress level these days?
Calm and relaxed most days Feel tensed many times Feel tensed almost every dayaffects mood, sleep, or daily life
How would you describe your typical energy during the day?
Energetic most of the time Varies - sometimes energetic, sometimes tired Feel tired or low on energy most of the time
Are you currently taking any supplements or vitamins for hair?
Yes No
Which of these best describe your Food Habits on most days?
I mostly eat healthy homely meals, on time I mostly eat healthy homely food, but often skip meals I often eat junk foodMore than 5 times a week
What's the main thing on your mind?
There are no wrong answers. Pick what feels closest.
I've noticed more shedding than usual My scalp doesn't feel comfortable I'm noticing breakage or dryness I'd like a routine that feels manageable
Which best describes your hair-care routine?
We'll keep your starting point practical.
I have a routine I follow It changes from week to week I'm still figuring out what works for me
How does your scalp usually feel?
Choose the description that sounds most familiar.
Mostly comfortable Often dry or tight Sometimes itchy or irritated Gets oily quickly