Hair & Scalp Health Assessment
Let's understand what your hair is telling you.
Before your appointment, a few questions about your hair, your health, and your routine. Anika reads every answer before you sit in the chair — so your time is spent on your hair, not on paperwork.
8–10 minMost people finish faster
PrivateSeen only by your stylist
You keep itYour summary at the end
This is an assessment, not a diagnosis. It helps Anika understand your hair and scalp — and tells you when something is worth showing a physician.
Section 1 of 7
About you
So we know who we're talking to, and how you'd like to hear back.
How would you rather we reach you?
Text message
Email
Phone call
Section 2 of 7
What brings you in
There are no wrong answers here. Say it however it comes out.
A sentence is plenty. "My edges are thinning" or "my scalp itches constantly" tells us a lot.
What would make this visit feel worth it to you?
Choose as many as apply.
Understanding why my hair is changing
Learning how to care for my scalp
Finding products that fit my needs
Preparing for a dermatologist visit
Tracking my progress over time
Getting a personalized hair care plan
Section 3 of 7
What you're noticing
Answer what applies. Questions that aren't relevant to you won't appear.
Are you noticing more shedding than usual?
No
A little more
Noticeably more
Handfuls
Is your scalp itchy, sore, or flaking?
No, feels fine
Occasionally
Often
Constantly
Have you noticed any of these?
Select any that apply, or skip.
Breakage along the length
A widening part
A receding hairline
Smooth or bare patches
Overall thinning over time
None of these
Has anyone in your family dealt with hair loss?
Mother's side
Father's side
Both sides
No
Don't know
Section 4 of 7
Health context
Hair is often the first place the body shows a change. These questions help Anika tell a hair problem from a health signal.
Are you taking any prescription medications?
No
Yes
Prefer not to say
Are you taking a GLP-1 medication?
Ozempic, Wegovy, Mounjaro, Zepbound and similar. We ask because rapid weight change is one of the most common causes of new shedding — and it's very manageable once we know.
Yes, currently
In the past
No
Prefer not to say
Do any of these apply to you right now?
Hormones drive a lot of hair change. Select any that apply — follow-ups only appear for what you choose.
Currently pregnant
Gave birth in the last 18 months
Currently breastfeeding
On hormone replacement therapy
In perimenopause or menopause
On birth control
Diagnosed with PCOS
Diagnosed with a thyroid condition
None of these
Have you ever been told you were low in any of these?
Iron
Vitamin D
Vitamin B12
Zinc
Anemia
Protein
None / not sure
Are you under the care of a dermatologist?
Yes
No
Seen one before
Products, ingredients, medications — anything that's caused a reaction.
Section 5 of 7
Your hair history
What your hair has been through matters as much as what it's doing now.
What have you had done over the years?
Select everything you've worn or had done, even years ago.
Color
Bleach or lightener
Relaxer
Jheri curl or similar
Keratin treatment
Silk press
Blow outs
Pressing combs
Braids or cornrows
Crochet
Locs
Wigs
Weaves
Sew-in attachments
Glued-on attachments
Tape or clip-in extensions
Tight ponytails
Ponytail attachments
Gel styles
Wash and go
Natural styles
Just cuts
How often do you use heat?
Never
A few times a year
Monthly
Weekly
Several times a week
How often you wash, what you use, what you do afterward. However you'd describe it to a friend.
Section 6 of 7
Life and wellness
Quick ones. Hair responds to sleep, stress, and what you eat more than most people expect.
How would you rate your stress lately?
Low
Manageable
High
Very high
Average sleep per night?
Under 5 hrs
5–6 hrs
7–8 hrs
8+ hrs
How would you describe how you eat?
Balanced
Mostly plant-based
Low carb / keto
Dieting / restricting
Irregular
Any notable weight change in the last year?
No
Lost a significant amount
Gained a significant amount
Do you take vitamins or supplements?
Yes
No
Has anything big shifted in the last year?
Select any. Life events show up in hair on a delay.
New job or career change
Relocation
Loss of a loved one
Pregnancy or postpartum
Major illness
Divorce or separation
Financial stress
None of the above
Section 7 of 7
Last thing
A few permissions, and you're done.
May Anika take photos of your hair and scalp?
Used in your record to track change over time. Never shared without asking you separately.
Yes, for my record
Yes, and may share anonymously
No
Required
I understand this assessment is not a medical diagnosis, and that Anika is a hair and scalp professional — not a physician.
I've read and agree to the privacy policy.
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Your summary
Your assessment summary
Hair & Scalp Health Assessment
Prepared for you
In your words
—
What you told us
What this suggests
Before your visit
Where to start
Recommended
Comprehensive Hair & Scalp Health Assessment
A full standardised assessment with microscopic analysis, photography, and a personalised report.
Book this service
This summary reflects what you reported and is intended to guide your appointment. It is not a medical diagnosis and does not replace evaluation by a physician or dermatologist. If anything here concerns you, Anika can help you prepare for that conversation.