Where has my hair gone?

ALISON'S TOP TIP

'Life goes on with or without hair - just enjoy your membership!'

Alopecia survey

Please complete the following to help with our research.

1. Are you experiencing hair loss as a result of:

If you answered chemotherapy/ other medical reason/don’t know, please proceed to Question 4

2. What type of alopecia do you have?

3. When you were first diagnosed as having alopecia, how easy was it to find out more information about the condition?

4. Has your hair loss affected your eyebrows, eyelashes, fingernails and/or toenails?

5. Do you currently wear a wig or a hairpiece?

If answering no are you considering wearing a wig or hairpiece?

6. If you wear a wig where did you get it from?
Please specify:

7. How many wigs do you buy per year?


8. Are you aware of any other hair loss websites?
If Yes please specify the name of the site


9. Do you have any further suggestions regarding products and services that have helped you to cope with hair loss?


Personal details

Name: *


Address: *


Email: *


Telephone:


Gender: *

Age Range: *

Where did you hear about this site?
Please specify:

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