Hi, my name is Zak and I am from Melbourne, Australia. I am currently in New York writing a book for people experiencing hair loss in all forms.  My book is formed in three parts; 1. Real stories, real people, real solutions; 2. The very latest facts and information about all types of hair loss; 3. A 30 day personal process to free people of the negative emotions of hair loss and transform the way they see hair loss.  This questionnaire is going to further help me in the writing of this book. Please answer the questions openly and honestly.  All the information that you supply is completely confidential and will be used to ensure I have covered everything you need to know about your hair loss.  Please provide your email address so I can keep you informed of the books progress and send you a FREE copy when it is completed. If you have any questions please contact me at hairgrowth@live.com.au Thank you again, I really appreciate your help!

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Have you discussed your hair loss/hair thinning with any other professional? (hairdresser, trichologist)	- Yes No
If yes, what are the sites you visit and do you interact or read for new information?
Do you visit hair loss blogs or websites?	- Yes No
If yes, how did you find your experience? Please let us know what you have liked or disliked.
How do you feel about your hair loss/hair thinning?
Tell me about your hair loss/hair thinning story
What is your gender?	- Female Male
What is your age group?	- 20s 30s 40s 50s 60s 70s+
What do you know about hair loss/hair thinning?
Have you come to terms with your loss of hair?	- 1(not at all) 2 3 4 5 6 7 8 9 10 (completely)
If you are at terms with your hair loss/hair thinning, how long did this take you and what helped you?
If you have not come to terms with your hair loss/hair thinning, how do you feel right NOW about it?
Are there any further suggestions that may benefit this book?
Do you know of any further books or organisations that could help?
How much hair have you lost?
How has your hair loss/hair thinning negatively affected your life?
Why do you think you are losing or have lost your hair?
Do you feel that you are able to find out about new treatments, services or products that may assist you?
Have you spoken to a medical professional about your hair loss/hair thinning?	- Yes No
If yes, please describe the medical professionals diagnosis and any treatments you were given and any results you have seen.
If yes, did you experience any results or side effects?
Have you tried any cosmetic cover ups? (Toppik, toupee, wig)	- Yes No
If yes, were you given any advice, treatments or referrals? Please describe your experience and results
If no, is there a reason you have not? Please let us know if you have not felt comfortable to ask for advice.
What questions do you have regarding your hair loss/hair thinning?
If no, do you have an idea of the cause of your hair loss/hair thinning?
What are your beliefs around hair loss/hair thinning?
What do you think is the solution to your hair loss/hair thinning?
Have you tried any topical treatments? (creams, shampoos)	- Yes No
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