Hair Loss Assessment | Quick Scalp & Hair Test — URoots: Powered by QHT Clinic

Personal & Hair Loss History

Symptoms & Health Info

Treatment History & Goals

Contact & Submission

Enter your details

Select Your Gender

Male

Female

When did you notice hair loss?

Less than 1 month 1–6 months 6–12 months Over 1 year

Select Hair Loss Pattern

Receding hairline

Thinning crown

Both crown and hairline

Patchy hair loss

Diffuse thinning

Complete baldness

Is your hair loss

Gradual over time Sudden or rapid

Scalp Symptoms

Medical Conditions

High or low blood pressure Prostate-related issues Mental health conditions (e.g. anxiety, depression) Trying for a baby / planning pregnancy Asthma None

Medications or supplements

Any Ongoing Hairloss Medication

Treatment Goal

Stop hair loss Regrow hair Increase density Not sure / Expert advice

Contact Details

Share your scalp pictures

Your head – Front, Side, Back & Top

Drag & drop images or Browse
JPG or PNG • You can upload multiple images

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