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Hair & Skin Assessment Quiz

Your Name

Your Email ( Here,You’ll receive your Free Report from Dr. Sharayu!)

WhatsApp Number

How often do you experience hair loss?

Rarely

Occasionally

Frequently

Almost always

How would you describe your hair type?

Thick and strong

Normal

Fine & thin

Weak & brittle

How often do you wash your hair?

Everyday

Every 2-3 days

Once a week

Less than once a week

How would you describe your scalp condition?

Healthy, no issues

Slightly dry or oily

Frequently itchy or irritated

Very flaky or inflamed

How would you describe your skin type?

Oily

Normal

Dry

Combination

How often do you experience skin breakouts (acne, blemishes)?

Rarely

Occasionally

Frequently

Almost always

How often do you exfoliate your skin?

Weekly

Monthly

Rarely

Never

How would you describe your skin’s moisture level?

Always well-hydrated

Usually hydrated

Sometimes dry

Always dry

How often do you drink water throughout the day?

Very often

Sometimes; I often forget to drink water during my work hours

Rarely

How much sleep do you usually get each night?

7-9 hours

More than 9 hours

4-6 hours

Less than 4 hours

How often do you exercise?

3-5 times a week

Everyday

Rarely; I don’t get time to exercise

Never

How sensitive is your skin to products or environmental factors?

Do you experience any skin conditions (e.g., eczema, rash, itching or psoriasis)?

Mild

Moderate

Severe

How satisfied are you with the current health of your hair?

How satisfied are you with the current health of your skin?

What is your main goal regarding your hair health?

Maintain current hair health

Improve hair condition

Regrowth and Shine

No specific goal

What is your main goal regarding your skin health?

Maintain current skin health

Improve skin texture and glow

Heal Skin conditions

No specific goal

Ever feel like your skin has a mind of its own—breaking out, drying up, or getting irritated for no reason? —What if your daily habits are secretly working against you?

Yes

Does your hair feel thinner, weaker, or just……not as vibrant as it used to be? Spoiler alert: It’s not just about the shampoo you’re using!

Yes

Maybe

Not really

Check all the symptoms and traits relevant to you

Dry, rough, or cracked skin

Thyroid & increasing weight

Thyroid & losing weight

Diabetes, Pre-diabetic or borderline diabetes/ INSULIN RESISTANCE

High blood pressure, high cholesterol & triglycerides along with palpitations on being stressful or anxious sometimes

LOW BP

PCOD/PCOS ( polycystic ovary )

Obesity & Over-weight

Too thin/ under-weight

Dandruff, itching & dull dry hair

Dandruff, scaly scalp, itching & oily hair

Acne & blemishes

Excessive skin dryness

Low Energy & tiredness

Low Immunity & easily prone to seasonal changes or seasonal infections like cold, cough or flu

Poor Digestion & upset stomach problems

Hormonal imbalance

Menopause problems

Lack of sleep / insomnia

Brittle nails

Excessive hair fall or thinning

Cold hands and feet

Sensitivity to cold weather

Joint pain, stiffness, cracking sounds in joints

Muscle twitching, spasms, tremors

Unintentional weight loss or difficulty gaining weight

Dry or chapped lips

Irregular digestion, bloating, excessive gas, constipation

Weak or low appetite (fluctuates often)

Dizziness, vertigo

Insomnia, disturbed sleep, difficulty falling asleep

Rapid, shallow breathing

Menstrual irregularities (scanty, painful, or irregular periods)

Restlessness, hyperactivity

Anxiety, worry, excessive overthinking

Forgetfulness, poor memory, lack of focus

Mood swings, nervousness, fearfulness

Feeling overwhelmed or scattered

Impulsive decisions, lack of consistency

Easily distracted, difficulty completing tasks

Speech becomes fast, unclear, or erratic

Excess body heat, feeling hot often

Excessive sweating with a strong odor

Skin issues like acne, rashes, redness, inflammation, boils

Oily skin and scalp, prone to breakouts

Sensitivity to sunlight, sunburns easily

Early graying or thinning of hair

Acid reflux, hyperacidity, heartburn

Loose stools, diarrhea, or frequent bowel movements

Excessive hunger and thirst

Strong cravings for spicy, salty, and fried foods

Strong body odor or bad breath

Yellowish discoloration of skin or eyes

Sharp, penetrating eyesight (but prone to redness, irritation, or burning sensation)

High energy levels, but prone to sudden exhaustion

Prone to headaches and migraines

Light sleep, often wakes up due to heat or dreams

Irritability, anger, short temper

Perfectionism, high expectations of self and others

Intense competitiveness, over-ambition

Impatience, intolerance to mistakes

Judgmental or critical behavior

Prone to jealousy and resentment

Obsessive focus, difficulty relaxing

Strong willpower but burnout due to overwork

Weight gain, difficulty losing weight

Sluggish digestion, slow metabolism

Feeling heavy, lethargic, sleepy throughout the day

Frequent congestion, sinus issues, mucus buildup

Water retention, swelling in hands, feet, puffiness on face

Excessive salivation, thick coating on the tongue

Low appetite but still prone to weight gain

Nausea or sluggish digestion after meals

Oily skin, prone to cystic acne

Greasy or thick hair, excess oil production on scalp

Cold body temperature, intolerance to cold and damp weather

Frequent colds, cough, allergies, asthma, respiratory issues

Sleepiness, difficulty waking up in the morning

Dull, slow reflexes

Slow but steady energy throughout the day

Feeling emotionally heavy, lack of enthusiasm

Depression, sadness, withdrawal from activities

Attachment to people, things, and habits

Resistance to change, difficulty letting go

Over-indulgence in food, especially sweet and comfort foods

Procrastination, lack of motivation

Brain fog, slow thinking, difficulty processing information

Excessive sleep, oversleeping, feeling tired even after rest

Are you unintentionally sabotaging your hair and skin health with small daily choices? Let’s find out—because a few tweaks might be all you need for that effortless glow!

Would you be interested in receiving a personalized detailed Nutrition & Wellness Plan for your Hair & Skin Revival & Rejuvenation from our expert?

I have a plan prescribed by my family physician or Dietician

I’m thinking about it & lookin for a nutritionist specializing in Hair & Skin nutrition & wellness

I haven’t considered it

No plan at all