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Hair Health
Internal Health
Scalp Assessment
Before we start, can we get your name?
Please enter your name
Your Mobile Number?
Enter valid 10-digit number
How old are you?
Please enter your age
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Hair Health
Scalp condition
Select
No dandruff / Normal scalp
Mild dandruff / dry flakes
Heavy dandruff / scalp itchiness
Diagnosed scalp condition (Psoriasis / Dermatitis)
How often do you shampoo your hair?
Select
Daily
2–3 times/week
Once a week
Less often
Do you apply hair oil? If yes — how many times in a week?
Select
Never
1 time/week
2–3 times/week
More than 3 times/week
Do you use hair-styling tools or chemical treatments (straightener, dyes, heat, etc.)?
Select
Never
Occasionally
Once a week
Multiple times a week
What hair issues have you noticed?
(Select all that apply)
Hair thinning / less volume
Excessive hair fall / shedding
Receding hairline
Patchy hair loss / bald spots
Since when have you noticed these hair issues?
Select
Less than 3 months
3–12 months
1–3 years
More than 3 years
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Internal Health & Lifestyle
Average sleep per night
Select
Less than 5 hours
5–7 hours
7–9 hours
More than 9 hours
Stress level
Select
Low
Moderate
High
Very High
Regular diet type
Select
Vegetarian
Non-Vegetarian
Vegan
Mixed
Average water intake/day
Select
less than 4 glasses
4–6 glasses
6–8 glasses
greater then 8 glasses
Do you have any diagnosed health conditions?
Thyroid
PCOS / Hormonal (if applicable)
Anemia / Vitamin deficiency
Diabetes
Other (specify below)
Currently taking any medicines or supplements? (If yes, name them)
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Upload Your Scalp Images
Front Scalp
Camera
Gallery
Top Scalp
Camera
Gallery
Crown Area
Camera
Gallery
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