Question 1 of 6

Do you find that there are a lot hairs on the brush after you have brushed your hair?

Not at all
A little bit
To some extent
A lot
Very much

Question 2 of 6

Do you consider yourself to be experiencing hair loss?

Not at all
A little bit
To some extent
A lot
Very much

Question 3 of 6

Do you find that your hair easily breaks and feels brittle?

Not at all
A little bit
To some extent
A lot
Very much

Question 4 of 6

Do you feel that your hairline is retreating further back on your head?

Not at all
A little bit
To some extent
A lot
Very much

Question 5 of 6

Do you think that you have fewer and/or thinner hair on your head now than just one year ago?

Not at all
A little bit
To some extent
A lot
Very much

Question 6 of 6

Are you having trouble getting your hair to grow longer?

Not at all
A little bit
To some extent
A lot
Very much
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