FREE Toppik Hair System when you complete the hair123.co.uk Survey

We are looking for 100 people with hair loss or thinning hair to take part in our survey. Simply answer the questions below and we will send you the Toppik Hair system COMPLETELY FREE OF CHARGE for you to try in your own home. Please read the terms and conditions then follow the simple on screen instructions.

Terms and conditions

Offer not open to existing Toppik UK or Hair123.co.uk customers
Offer only available to mainland UK residents
Free Hair Loss system restricted to the first 100 properly completed surveys received (the survey will be removed from this website when the 100 are received)
The contents of this survey will not be linked any individual, results will be collated for internal analysis and possible publication.
You are sending your name and address for delivery of the FREE hair loss system and for follow up commutation from us.
Your details will not be sold rented or passed onto any third party.
we will not contact you if you are ineligable to receive the free toppik hair system

Please enter 'none' for any questions that aren't applicable to you.

Do you Agree to the Terms and Conditions?	I Agree I Disagree
At what age did you start using your hair?
Which non-prescription products (if any) have you used for your hair loss?
Enter the word 'none' if this question doesn't apply
Which prescription medications for hair loss (if any) have you used?
Enter the word 'none' if this question doesn't apply
Have you ever had a surgical hair replacement procedure?
Have you ever enquired about a surgical hair replacement procedure?
Is your hair loss at the crown, receding at the front, or both?
Had you heard about Toppik before today?
Which shampoo do you use?
Enter the word 'none' if this question doesn't apply
Do you Towel dry or Blow dry your hair?
Do you comb your hair (either with a comb or a hairbrush)?

What do you think the main reason for your hair loss is?	Hereditary Lifestyle Use of hair products (shampoos, Gels, Hair wax etc) Stress Medication taken
Other (please write in the box)

Would you tell anyone that you use hair loss treatments or products?
Please list the hair loss products or treatments you have heard of?
Enter the word 'none' if this question doesn't apply
Do you believe that Hair transplants work?
If a hair loss treatment or product worked would you tell a friend with hair loss?

Thank you, please now enter your name and address for us to send you your FREE Toppik Hair System

Title
First name
Last name
Find your address (Enter your postcode)

Address line 1
Address line 2
Address line 3
Post code
Email Address
Hair Colour

Please click Submit to complete the survey and submit your details (you will be returned to the Centre for hair loss)

FREE Toppik Hair System when you complete the hair123.co.uk Survey

Thank you, please now enter your name and address for us to send you your FREE Toppik Hair System

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FREE Toppik Hair System when you complete the hair123.co.uk Survey

Thank you, please now enter your name and address for us to send you your FREE Toppik Hair System

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