The Baldie Survey
We have a special definition for BALDIE-- Beauty and Love Demonstrated in Everything. This survey is to help us learn more about you and your journey, so that we have better support and serve you.

*Complete and enter to receive a free Baldie tee of your choice from TheBaldieShop.com

Stay connected on Instagram: @TheBaldieMovement
We frequent on Facebook: https://www.facebook.com/groups/TheBaldieMovement/
Join our private Facebook group https://www.facebook.com/groups/TheBaldieMovement/

Full Name *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Email *
Your answer
Phone Number *
Your answer
Age *
Your answer
What caused your baldness? *
Required
Have you been diagnosed with a specific hair loss condition? (If "yes" please describe) *
Your answer
Tell us about your relationship with your baldness. How has it affected your life? How does it make you feel? Feel free to tell us as much as you would like. *
Your answer
How long have you been experiencing hair-loss? *
Your answer
What negative behaviors have you experienced since your hair loss began? *
Required
How does your baldness currently make you feel? *
Required
Do your friends and family support you through your journey as a bald woman? *
Has your hair-loss harmed your self esteem? *
What makes you feel more beautiful as a bald woman? *
Required
Do you wear wigs or head coverings to hide your baldness in public? *
Do you avoid running errands or going to the store due to your baldness? *
Do you skip social outings or events due to your baldness? *
Have you cut back on exercise or outdoor activities due to your baldness? *
Do you believe your baldness has negatively affected your career? *
If yes, how? *
Your answer
Does your baldness cause you to feel uncomfortable around your colleagues? *
Have you been late to work or an appointment due your baldness? *
Do you believe your baldness has had a negative affect on your romantic relationship? *
Have you had a relationship end due to your baldness? *
Do you believe men or women find you less attractive due to your baldness? *
What workshops would you like to attend to help you love yourself without the need of hair? *
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Shanell Coleman. Report Abuse - Terms of Service - Additional Terms