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One Powerful Formula. One Quick Survey.

Before we prescribe your treatment, we need to make sure it’s right — and safe — for you.

Thryve Hair Lab offers a single, doctor-formulated medication with four proven ingredients.

A quick medical survey is required to confirm you're eligible and ensure the treatment is safe for you. It takes just 2–3 minutes and is reviewed by a licensed provider.

Your hair goals. Our science.

Take 2 minutes to complete this quick survey.
Your responses help us determine if you're a good fit for our 4-in-1 hair loss solution. A licensed medical professional will review and approve your answers before we ship.

Where are you noticing hair loss? *

Front

Crown

Both

Full Name *

Phone *

Email *

Date of birth *

Address

Street Address

City *

State *

Country *

Postal code *

Do you have any chronic medical conditions? (Check all that apply) *

If Others, please mention

Are you currently taking any medications? *

Yes

No

Describe which medication you taking

I acknowledge that I am submitting this form as part of a telehealth consultation and that the provider may use this information to assess my eligibility for treatment.

I confirm that the information provided is accurate to the best of my knowledge.

Signature *

Clear