hair loss analysis

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    *Please answer all questions.


    1. WHEN DID YOU NOTICE YOUR HAIR LOSS?


    2. WHAT TYPE OF HAIR LOSS DO YOU HAVE?
    THINNING HAIRALOPECIACHEMOTHERAPY/RADIATIONOTHER


    3. DID YOU CONSULT A DOCTOR ABOUT YOUR HAIR LOSS?
    NOYES


    4. HAVE YOU DONE ANYTHING PREVIOUSLY ABOUT YOUR HAIR LOSS?
    ROGAINEPROPECIAOTHER


    5. DID YOU SEE ANY RESULTS?
    YESNOSOME


    6. DO YOU AVOID SOCIAL SITUATIONS DUE TO YOUR HAIR LOSS?
    YESNOSOMETIMES


    7. HAS ANYONE COMMENTED ABOUT YOUR HAIR LOSS?
    YESNO


    8. ARE YOU ON MEDICATION?
    NOYES


    9. ARE YOU ALLERGIC TO ANYTHING?
    NOYES


    10. HOW DID YOU LEARN ABOUT US?


    11. HOW MANY TIMES DO YOU WASH YOUR HAIR PER WEEK?


    12. DO YOU SUFFER FROM ITCHINESS OF THE SKIN?
    YESNOSOME


    13. DO YOU SUFFER FROM DANDRUFF?
    YESNOSOME


    14. DO YOU HAVE GREASY HAIR?
    YESNOSOME

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