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Hair Self-Diagnosis
Self-diagnosis form
First Name
Last Name
Email Address
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Phone
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Age
Gender
Man
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Family history of alopecia
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Father
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Nobody
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Do you consider your hair loss to be stable?
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Areas to be repaired in hair transplantation/restoration
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Frontal
Middle zone
Crown
Eyebrow
Beard
Scar
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Have you had any hair treatments?
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No
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