Hormones to Hairlines Quiz
First Name
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Last Name
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Email
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Phone
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How often do you use a gentle scalp detox or clarifying treatment to remove product, sweat, and buildup from your scalp?
Never
Rarely
Sometimes
Often/Always
In the last 3 months, how often has your scalp felt itchy, sore, burning, or extra sensitive?
Never
Rarely
Sometimes
Often/Always
How often do you notice flakes, greasy patches, or visible buildup on your scalp or around your hairline?
Never
Rarely
Sometimes
Often/Always
How often do you wear tight styles that pull on your hairline or crown (tight ponytails, braids, slick-back styles, extensions, etc.)?
Never
Rarely
Sometimes
Often/Always
In the last 12 months, how often have you used chemical treatments like relaxers, bleach, strong dyes, or straighteners on your hair?
Not at all in the last year
1 - 2 times
3 - 6 times
Monthly or more
How often do you use hot tools (flat iron, curling wand, blow dryer without heat protectant) on your hair?
Never
Rarely (1–2 times per month)
Sometimes (1–2 times per week)
Often/Always (3+ times per week)
Which best describes your current hair products and routine?
I use a random mix of products I’ve collected over time.
I have a few favorites, but no real routine.
I follow a simple routine, but it’s not built for menopause-related hair loss.
I follow a consistent system designed for my hair and scalp needs.
Over the last 3 months, how would you rate your overall stress level (work, family, health, life)?
Very low
Manageable
High
Very high
How many nights per week do you get at least 7 hours of sleep that feels somewhat restful?
0 - 1 nights
2 - 3 nights
4 - 5 nights
6 - 7 nights
How consistently do you nourish your body in ways that support hair health (regular meals with protein, water, and key nutrients like iron, vitamin D, etc.)?
Rarely think about it
I think about it, but my habits aren’t consistent
I’m fairly consistent most weeks
I’m very intentional and consistent
Which best describes what you’re dealing with right now? (Select all that apply)
I’ve just started noticing more shedding than usual.
My part is widening / my scalp is more visible.
I have bald spots or obvious thinning areas I’m trying to cover.
If we could help you change ONE thing in the next 90 days, what matters most?
Slow down or stop the shedding.
Get thicker, stronger hair overall.
Feel confident wearing my hair without hiding it all the time.
What feels like your biggest obstacle right now?
I’ve tried products and nothing seems to work long-term.
I’m overwhelmed by advice online and don’t know what to trust.
I’m worried about harsh chemicals and side effects.
I’m not sure if my hair loss is “bad enough” to get help yet.
How do you prefer to be helped with this?
I want a clear step-by-step plan or challenge to follow so I can start fixing this now.
I want a one-on-one expert to look at my hair and tell me exactly what to do before it gets worse.
If we could help you fix ONE thing about your hair in the next 90 days, what would it be?
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