Hair Care Questionnaire

1. Are you Male or Female?
Male
Female

2. What is your Age Range?
Under 20
20-39
40-59
60 and over

3. What type of hair do you have? (check all that apply)
Thick
Fine
Thin/Thinning
Coarse
Average thickness

4. What condition is your scalp?
Normal
Oily
Dry

5. What are your current hair problems?

6. Have you had any major hair loss in the last 6 months?
Yes
No

7. What would you like a hair product to do for your hair?

8. What is your email address? (so we can contact you with product recommendations)