Hair & Scalp Screening | PURE Medical Spa Chicago

Step 1 of 14

Let's get started

A few basics so we can read your hair loss the way a clinician would. This version asks more, to tell apart a wider range of causes.

Age range

Sex at birth (helps interpret common patterns)

FemaleMalePrefer not to say

Please choose your age range and sex to continue.

Step 2 of 14

About the hair loss

How long it has been going on, and how it behaves.

When did it start?

How did it begin?

Is it mostly:

Lately it has been:

Getting worseStableImproving

When you lose a hair, is it:

Full hair with a white bulbShort, broken hairNot sure

Roughly how much are you losing?

Please answer at least the first three questions to continue.

Step 3 of 14

Where is it most noticeable?

Select all that apply.

Step 4 of 14

Scalp signs & symptoms

Select all that apply.

Step 5 of 14

Recent triggers

Select anything that applies in the last 6 months.

Illness, fever, COVID, surgery or hospitalizationMajor stressWeight loss, dieting, GLP-1 medication or low proteinThe shedding started about 2 to 6 months after one of theseThe hair fell out very fast, within days to weeksFamily history of hair loss

Step 6 of 14

Hormonal & reproductive

Select anything that applies.

Step 7 of 14

Medical history

Select anything that applies.

Step 8 of 14

Medications

Select anything you take or have recently started.

Do not stop any prescribed medication on your own. This is only to help interpret timing with your clinician.

Step 9 of 14

Hair care & styling

Select anything that applies.

Tight ponytails, buns, braids, extensions, wigs, weaves, locs or clipsYour hairstyle sometimes makes the scalp soreRelaxers, bleach, keratin, perms, frequent heat or tight brushingYou notice breakage after stylingDamage is worse at the ends / chemically treated lengthsLong-standing tight-styling habits over years

Step 10 of 14

Infection & exposure

Select anything that applies.

A child you are close to has scalp scaling, patchy loss or ringwormA pet has skin patches or ringwormShared hats, combs, helmets or pillowsOthers in the household have similar scalp problemsSwollen lymph nodes in the neck

Step 11 of 14

A few habit questions

There are no wrong answers here. Select anything that applies.

You sometimes pull, twist, pick or break hairsIt tends to happen during stress, focus, reading, driving or TVYou feel relief afterwardEyebrows or eyelashes are affectedIrregular or odd-shaped patchesHairs of different lengths within a patch

Step 12 of 14

Diet & nutrition

Select anything that applies.

Step 13 of 14

Clinical exam & labs

Usually completed by your PURE clinician. If you are screening at home, leave these blank and continue.

Optional. These findings sharpen the result but are not required.

Hair pull test

PositiveNegativeNot performed

Labs available?

Low ferritin / ironAbnormal TSH / free T4

Step 14 of 14

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

Let's get started

About the hair loss

Where is it most noticeable?

Scalp signs & symptoms

Recent triggers

Hormonal & reproductive

Medical history

Medications

Hair care & styling

Infection & exposure

A few habit questions

Diet & nutrition

Clinical exam & labs

Almost done