Hair Loss

What best describes your hair and where you are noticing hair loss? Please select all that apply.

When did you first notice signs of hair loss?

What is your goal for your hair?

Are you currently experiencing any of the following?

Do any of the following currently apply to you?

Have you seen a doctor in the past for hair-related symptoms?

Have you tried any of these treatments?

Have you tried any other treatments in the past? If yes, what was the treatment and was it successful?

Have you experienced any reactions more than 4 weeks after starting a previous treatment?

Do you have a preferred medication?

Is there anything else related to treatment that you'd like to ask or discuss with your medical provider?

Do you have a preferred treatment?

Would you like to share anything else with your provider through an upload?

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