Since 1928VHCA Hair Clinic World's 1^st Ayurveda Hair Clinic

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Step 1About You

Step 2Hair Health

Step 3Internal Health

Step 4Scalp Assessment

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Let's get startedWhat should we call you? Next  

Your Contact DetailsPhone NumberEmail Next  

More About YouYour AgeGender

Male

Female

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What best describe your condition?

ALOPECIA AREATA (बालों में कीड़ा लगना)

ALOPECIA AREATA / बालों में कीड़ा लगना

DANDRUFF / रूसी

DIFFUSA (ज्यादा बाल झड़ना)

FEMALE PATTERN BALDNESS / महिलाओं में गंजापन

GREYING OF HAIR / कम उम्र में बाल सफेद होना

SCARRING ALOPECIA

SEBORRHOERIC DERMATITIS / ऑयली डैंडरफ

SPLIT HAIR / दोमुंहे बाल

TRICHITILLOMANIA / बाल खींचना

पुरुषों में गंजापन (MALE PATTERN BALDNESS)

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Any Family History of Hair Loss?

Yes

No

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Any Medical History in Last 1 Year?

Yes

No

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How well do you sleep?

Very peacefully, 6-8 hours.

Disturbed Sleep.

Have difficulty falling asleep.

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How stressed are you?

No Stress.

Low

Moderate (work, family etc.)

High (loss of close one, separation, home, illness)

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Do you feel constipated?

No/Rarely

Yes

Unsatisfactory bowel movements

Suffering from IBS (irritable bowel syndrome)/dysentery

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Any health issue?

Yes

No

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How are your energy levels?

Always high

Low when I wake up, but gradually increases.

Very low in afternoon

Low by evening/night

Always low

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Are you taking any supplements/vitamins?

Yes

No

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