Where has my hair gone?

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

Alopecia

Chemotherapy/other medical reason

Don’t know

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

2. What type of alopecia do you have?

Alopecia areata (patches of baldness)

Alopecia totalis (all scalp hair has gone but eyebrows and eyelashes remain)

Alopecia universalis (all body hair has gone including eyebrows, eyelashes, underarm hair and any other sites on the body where hair is normally present)

Not sure/Don't know

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

Fairly easy

Very easy

Fairly difficult

Very difficult

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

Eyebrows

Eyelashes

Fingernails

Toenails

None of these

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

Yes

No

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

Yes

No

Unsure

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

NHS

Specialist wig retailer

Elsewhere (please specify below)

Please specify:

7. How many wigs do you buy per year?


8. Are you aware of any other hair loss websites?

Yes

No

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?

Yes

No

Name: *


Address: *


Email: *


Telephone:


Gender: *

Female

Male

Age Range: *

10 - 30 years old

31 - 45 years old

46 - 60 years old

60 years or above

Where did you hear about this site?

Magazine (please specify below)

Word of Mouth

Search engine (please specify below)

Social Networking Website (please specify below)

Trevor Sorbie’s My New Hair Initiative

Other (please specify below)

Please specify: