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Apply to participate in a FNS user trial

12 people (male and female) will be selected to participate in a FNS user trial. Participants will receive a 10 month supply of FNS (5 x bottles) in exchange for providing pictures and updates on their progress every month.

Comments and pictures will be displayed on Hairlosshelp.com and Osmotics will have the right to use any pictures and/or testimonials from trial participants on their web site or in marketing materials.

Trial is open to anyone regardless of their current treatment program.

There will be 4 groups of 3 participants chosen.

Group 1 - Men not using any hair loss products.
Group 2 - Men using Propecia and no topicals.
Group 3 - Men using several products simultaneously.
Group 4 - Women not using any hair loss products.

How it works

You complete the application form below and if selected you will receive regular supplies of FNS. Every month you will be required to update your progress with pictures and comments describing your results. You will receive each month's supply on completion and submission of the previous months pictures and feedback.

Application form

Age:

Sex:

Male

Female

How long have you suffered from hair loss?

years

What is the diagnosed cause of your hair loss?

How severe is your hair loss?

If unsure please see the following charts

Have you ever had hair transplant surgery?

Yes

If so, how long has it been since the last procedure?

What hair loss products are you currently using now?

What hair loss products have you tried within the past 12 months but are no longer using?

Are you on medication for any other condition besides hair loss?
(If so please list them.)

You will need to take digital pictures of your hair line before you start. (The better the pictures you take the more likely you are to be accepted.) Take pictures of the frontal hair line, the crown, the back, and a shot from the top. You can upload the pictures below. Take pictures in front of a white background in a naturally lit area. Outdoors during the day is preferable.
(IMPORTANT - Please make sure that the pictures are in jpg format)

Frontal Hairline
Crown
Top of head
Back of head

Personal Details

Name:

Address:

City:

State/Province:

Zip/Postal Code:

Contact Phone #:

Email address:

Inclusion in the study is not guaranteed by completing this form.
You will be contacted if you were selected.
If you were not selected your information will not be disclosed to any other party
besides those involved with this study.

If you are uploading several pictures it will take a few minutes to process, please do not resubmit the application.