How long have you been experiencing hair loss? Less than 6 months6 months to 1 year1-5 YearsMore than 5 years
Are you experiencing excessive shedding? More than 100 hairs a day. YesNo
Does hair loss run in your family? YesNo
Have you had any recent health changes? No ChangesSurgeryMedicationStressDietCancerOther
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