The Baldie Survey
This survey is to help us learn more about you and your journey, so that we have better celebrate, support, and empower you.


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Full Name *
Address *
City *
State *
Zip Code *
Email *
Phone Number *
Age *
What caused your baldness? *
Required
Have you been diagnosed with a specific hair loss condition? (If "yes" please describe) *
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. *
How long have you been experiencing hair-loss? *
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? *
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 events would you like to attend to help you love yourself more without the need of hair? *
Required
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