Lawrence Cutsinger's Hair Care Survey

Please Enter Your First Name (or alias):
Please Enter Your City:
Please Enter Your State or Province:
Your Sex: Male Female No Reply
Select Your Age Range:
At what AGE did you notice hair loss?
Was your first NOTICEABLE hair loss where you usually FIRST apply shampoo to your head? Yes No No Reply
What is the LOCATION of your first noticeable baldness?
Are You Left Handed Or Right Handed? Right Left No Reply
What type of hair do you have?
Do you have gray hair?
Men: Is your haircut:
Men and Women: Please Answer Yes Or No To the Following
Do you have curly hair? Yes No No Reply
Do you have very oily hair? Yes No No Reply
Do you have "thick" hair? Yes No No Reply
Do you have LARGE diameter hair? Yes No No Reply
About Your Hair Care
Does your shampoo contain Sodium (or Ammonium) Laurel Sulfate (or Laureth Sulfate)? Yes No No Reply
How often do you wash your hair?
How long do you wash your hair?
Do you diligently rub into scalp: Yes No No Reply
Do you "repeat"? Yes No No Reply
Do you rinse immediately or wait a while? Rinse Immediately Wait No Reply
If you use hair conditioner, gel, or hairspray, what is the approximate COMBINED TOTAL of times per week that you use those products?
Additional Information
Are you a visitor who is balding (or know someone who is) but need MORE persuasion even after having read getitback.com? Yes No No Reply
Are you a spectator (which would include media, government, soap and cosmetic industries)? Yes No No Reply
Are you willing to show before and after photos of your test results? Yes No Maybe No Reply
Are you considering conducting a formal test (Student Groups / Professors)? Yes No Maybe No Reply
Comments? Please be brief.
(254 character Limit)