Ayurvedic Hair Health Assessment

Complete this assessment to receive personalized Ayurvedic recommendations

Personal Information

Full Name*

Email Address*

Phone Number*

Date of Birth*

Height (Feet)*

Height (Inches)*

Weight (kg/lbs)*

Gender*

Male

Female

Other

Hair Health

Tell us about your current place:*

Coastal (humid areas)

Plain (central region)

Mountains

What kind of weather are you expecting over the next 60 days?*

Cold and Dry

Mild and Pleasant

Rainy and Humid

Hot and Dry

Extreme Heat

Select your Hair Type:*

Straight

Wavy

Coil

Curly

Preferred water temperature for hair wash:*

Cold

Warm

Hot

What type of water do you use for hair wash?*

Hard

Soft

I Don't Know

How frequently do you use shampoo/conditioner?*

3+ times/week

1-2 times/week

1-2 times/month

Never

How frequently do you dye/colour your hair?*

Monthly

2-4 months

6 months

Don't dye

How often do you use heat-styling tools?*

Daily

Weekly

Monthly

Never

How many times do you oil your hair in a week?*

Never

2-3 days

4+ days

How was your hair in your younger years (below 25)? (Select all that apply)

Soft

Curly

Straight

Dry

Oily

Dense

Silky

Rough

Sticky

Thick

Do you have a family history of early baldness?*

Paternal

Maternal

Siblings

None

Does someone who stays with you experience similar hair problems?*

Yes

Internal Health

Do you have any of these health conditions? (Select all that apply)

Diabetes

High BP

Low BP

Thyroid

High Cholesterol

Psoriasis

Heart Disease

Anemia

Rheumatoid Arthritis

Asthma

None

Have you experienced any of these in the last 3 months?*

Malaria

Dengue

Typhoid

None

What type of hair medication are you currently using?*

Internal

External

None

How stressed are you?*

High

Special

Normal

Low

How do you rate your sleep quality?*

Poor

Sound

Sleepy

How do you rate your appetite or eating capacity?*

Poor

Inconsistent

Moderate

Excellent

How is your bowel movement?*

Poor

Normal

Loose

Which taste do you like the most?*

Spicy

Sweet

Salty

Sour

Bitter

How often do you consume non-veg food (excluding eggs)?*

Vegetarian

4+/week

1-3/week

1-3/month

How often do you eat food cooked outside?*

5+/week

2-4/week

2/month

Home-cooked

What does your daily work primarily entail?*

Sit

Stand

Travel

None

What do you regularly use for commuting?*

Car

Public

2-wheeler

None

Which of the following items do you consume frequently? (Select all that apply)

Cigarettes/Vape

Alcohol

Tobacco

Cold Drinks

Tea/Coffee

None

How often do you sleep late at night?*

5+/week

2-4/week

2/month

Rarely

In the last 2 months, what is true about your weight?*

Gained

Lost

Same

How often do you work out/play sports/exercise?*

5+/week

4-5/week

2-3/week

Scalp Assessment

Your scalp naturally tends to be:*

Dry/Very Dry

Normal/Dry

Normal/Oily

Oily/Very Oily

The top 3 concerns that you are facing presently (Select any 3):

Hair Fall

Breakage/Split ends

Dandruff

Greying

Poor growth

Itchy scalp

Frizzy hair

Burning sensation

Blisters

Select the severity of your problems:

Itchy scalp:

Mild

Moderate

Severe

Burning sensation on the scalp:

Mild

Moderate

Severe

Blisters on the scalp:

Mild

Moderate

Severe

How did your problem start?

Itchy scalp:

Suddenly

Gradually

Burning sensation on the scalp:

Suddenly

Gradually

Blisters on the scalp:

Suddenly

Gradually

If you don't apply anything to your hair, your hair tends to be:*

Rough

Sticky

Thin

None

Do you experience bad odor from your hair/scalp?*

Always

Sometimes

Never

Do you have skin problems similar to those on your scalp (itching/scaling)?*

Yes

Thank You!

Your Ayurvedic hair health assessment has been submitted successfully.

Our Ayurvedic experts will analyze your responses and provide personalized recommendations within 24 hours.

Truvie Ayurveda

Test the hair

Ayurvedic Hair Health Assessment

Personal Information

Hair Health

Internal Health

Scalp Assessment

Select the severity of your problems:

How did your problem start?

Thank You!