Product Testing Questionnaire
Thank you for your interest in our hair regrowth product study. Completion of this form is not a guarantee that you will be selected for the study. Your information will be kept confidential.
Email address *
Name *
Sex *
Phone number *
Why do you feel you have hair loss? (check all that apply) *
Is your hair thinning or completely bald?
Clear selection
How long have you been experiencing hair loss?
Where on your head is the hair loss?
This process may take up to 60 days. Can you commit to using the products as instructed in order to possibly achieve maximum results?
Clear selection
If chosen will you agree to NOT discuss the trial or products with anyone?
Clear selection
Do you understand results are NOT guaranteed? We are testing natural products to attempt hair regrowth.
Clear selection
Are you willing to sign documents such as non disclosure agreements and release of liability?
Clear selection
Are you willing to provide photos to our company of your head and possible hair growth throughout the trial?
Clear selection
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