Hair & Scalp Screening | PURE Medical Spa Chicago

Step 1 of 7

Let's get started

A few quick basics so we can read your hair loss the way a clinician would. About three minutes.

Who is this screening for?

MyselfMy child (under 12)

Age range

Sex at birth (helps interpret common patterns)

FemaleMalePrefer not to say

Please answer all three to continue.

Step 2 of 7

About the hair loss

How it started and how it behaves.

When did you first notice it?

What best describes it?

Lately it has been

Getting worseStableImproving

Do lost hairs have a white bulb at the end, or look like short broken pieces?

White bulbShort brokenNot sure

Please choose when it started and what best describes it.

Step 3 of 7

Where is it most noticeable?

Select all that apply.

Step 4 of 7

Scalp signs & symptoms

Select all that apply.

Step 5 of 7

Recent changes & history

Select anything that applies.

In the last 6 months

A major illness, fever, COVID, surgery, or stress 2 to 6 months before it beganSignificant weight loss, dieting, GLP-1 medication, or low protein intakeStarted a new medication or changed a doseGave birth in the past 2 to 6 monthsStarted or stopped hormonal contraceptionHeavy or prolonged periods

+

Health history

Step 6 of 7

Habits & exposures

Select anything that applies.

Hair practices

Tight ponytails, buns, braids, extensions, wigs, weaves, locs, or clipsYour hairstyle causes scalp sorenessRelaxers, bleach, keratin, perms, frequent heat, or hard brushingYou notice breakage after styling

!

Infection & exposure

A child at home has a scaly patch or hair lossA pet has skin patches or ringwormSharing hats, combs, helmets, or pillowsSwollen lymph nodes in the neckA scaly patch with broken hairs or black dots

?

Hair-pulling habits

You sometimes pull, twist, pick, or break hairsYou feel relief after pullingAffected patches have hairs of clearly different lengths

+

Medical & medications

Chemotherapy or radiation now or recentlyRapid loss over days to weeksThyroid imbalance symptoms (cold or heat intolerance, weight change, palpitations)PostmenopausalTaking a retinoid, anticoagulant, anticonvulsant, beta blocker, antidepressant, antithyroid drug, testosterone/hormone, or biologic

Step 7 of 7

Almost done

We'll email your personalized report here, and a PURE clinician will review it.

Full name

Email

Phone (optional)

Please add your name and a valid email, and check the box to continue.

PURE Regrow