Please fill out the following hair loss assessment form.
Your Hair Loss Evaluation
2. Your natural hair colour is?
3. Which best describes the texture of your hair?
4. What is the texture of your hair?
5. Click on the image that matches your hair loss condition when your hair is wet.
6. You noticed your hair loss at what age?
7. What are your expectations from hair transplantation (restore the front hairline, mid scalp, back, or your entire balding area)?
8. Have you consulted with a doctor about your hair loss condition?
9. Were you recommended any treatment for your hair loss?
10. Have you had a hair procedure before?
If so with whom?
11. Have you used any of these oral & topical medications for your hair loss?
12. Has your hair loss had an affect on your life, if so in what way?
Feel free to send your comments or questions:
Your Contact Information
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