Free Doctor-Led Hair Consultation Test - Adon Hair Care

Pre Assessment info
Please Introduce Yourself

Your Hairloss, Dandruff, Scalp Condition

Hair Related Medical Conditions

Your Scalp Image for better Treatment

Before we start, can we get your name?

Gender

Male

Female

How old are you?

Phone Number?

Email

Hairloss:-
Active hair loss per day

less than 25

25-50

51-100

101-200

101-200

Duration ?? ( From when hairloss started)

Treatment taken in past

Yes

No

If yes then what were the result and which medicines took in past ??

Please select one of the below options depending on which side of your family had or have hairfall issue

Father side

Mother side

Both

None

Dandruff

Dry

Oily/ Greasy/ Sticky

Seborrheic Dermatitis

None

Where do you stand?

Stage-1

Stage-2

Stage-3

Stage-4

Stage-5

Stage-6

Stage-7

Stage-8

Any disease in last 6 months

Dengue

Malaria

Typhoid

Covid

None

Any Chronic Disease

Anemia

Hypertension

Cholesterol

Diabetes

Thyroid

Any Other

None

Any Vitamin Deficiency

Yes

No

Your scalp image for better treatment

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Hairloss:-
Active hair loss per day

less than 25

25-50

51-100

101-200

More than 200

Dandruff

Dry

Oily/Greasy

Seborrheic Dermatitis

None

Duration ?? ( From when hairloss started)

Treatment taken in past

Yes

No

Have you done ?

Cysteine Therapy

Keratin

Hair Botox

Nano Plasty

Hair Straightening

Hair SPA

None

Where do you stand?

Acute disease in last 6 months

Dengue

Malaria

Typhoid

Covid

Surgery

Post Pregnancy

None

Any Chronic Disease

PCOS

Thyroid

Menopause

Weight loss / weight Gain

Anemia, Diabetes, BP , Cholesterol

None

Vitamin deficiency

Yes

No

Your scalp image for better treatment

Allowed formats - jpg, png

×

Preview Image

Add Image

Preview Image

Add Image

Preview Image

Add Image

Preview Image

Add Image

Preview Image

Add Image