Please complete this short form to begin your free Virtual Hair Health Assessment.
Your answers help our consultant identify possible causes of your hair concerns and prepare a personalised overview.
This takes just a couple of minutes, and your data is fully confidential.

Full Name *

Email *

Phone *

I consent to Novogenics contacting me to begin my virtual hair assessment and manage my enquiry.

What is your main hair loss concern today? *

Generalised – all over

Thinning

Widening part

Shedding

Other

Have you previously been diagnosed with a type of hair loss? *

Female Pattern Hair Loss (Androgenetic Alopecia)

Telogen Effluvium (stress/illness-related shedding)

Postpartum Hair Loss

Alopecia Areata (patchy loss)

Traction Alopecia (from tight hairstyles)

Scarring/Cicatricial Alopecia

No formal diagnosis

Unsure

Have you tried any treatments either from your doctor or over the counter – including: *

Other OR PRP/exosomes/polyneucleotides – if so please specify how many treatments of which

Are you looking for doctor led – PRP treatments and/or autologous (from your own blood) exosomes with or without microneedling? *

Yes I'm ready

I'm just exploring

Unsure

How soon are you hoping to start treatment ? *

Immediately

Within 4 weeks

Within 3 months

Just exploring options

Have you noticed any of the following? *

Does anyone in your family have hair thinning or hair loss? *

Yes — female relatives

Yes — male relatives

Unsure

Do you have regular menstrual cycles? *

Yes

Not applicable (postmenopausal)

Are you currently: *

Pregnant

Breastfeeding

Trying to conceive

None of the above

Are you taking any medications? *

Yes

If "yes" please list all (Contraception, Thyroid medication, Anti-androgens (spironolactone, finasteride), Steroids, Antidepressants/anxiolytics, Acne treatments (Roaccutane), Blood thinners, Other)

Which of the following apply to your current hair care or styling routine? (Select all that apply.) *

I regularly wear a hijab or head covering

I frequently wear tight hairstyles (e.g. ponytails, braids, buns)

I use chemical treatments (hair dye, bleach, keratin, relaxers)

I regularly use heat styling tools (straighteners, curlers, blow-dryers)

I use medicated or prescription shampoos

None of the above

Please select the options that best describe your current lifestyle.

Smoking *

I currently smoke

I do not smoke

Alcohol Intake *

I do not drink alcohol

I drink alcohol occasionally

I drink alcohol moderately

I drink alcohol frequently or in excess

Stress Levels *

My stress levels are low

My stress levels are moderate

My stress levels are high

Exercise *

I exercise regularly

I exercise occasionally

I do not exercise regularly

Sleep Quality *

My sleep quality is generally good

My sleep quality is average

My sleep quality is poor

Recent Major Life Stressor *

I have experienced a recent major life stressor

I have not experienced a recent major life stressor

Which statement describes your expectations? *

I understand results vary and take 8–12+ weeks.

I understand PRP/exosomes strengthen follicles but may not regrow fully bald areas.

I expect some density improvement.

I expect noticeable regrowth.

I expect hair-transplant level results.

I’m unsure and need clarity.

Which type of plan are you considering? *

Treatment Commitment - When are you ready to start? *

Please complete this short form to begin your free Virtual Hair Health Assessment.Your answers help our consultant identify possible causes of your hair concerns and prepare a personalised overview.This takes just a couple of minutes, and your data is fully confidential.

Please complete this short form to begin your free Virtual Hair Health Assessment.
Your answers help our consultant identify possible causes of your hair concerns and prepare a personalised overview.
This takes just a couple of minutes, and your data is fully confidential.