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Non-surgical Hair Restoration Questionnaire

Explore tailor-made treatments. Take the first step to fuller hair today!

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Hair Loss History:

Check all that apply

Current Hair Care Routine:

Check all that apply

Lifestyle and Health:

(e.g., thyroid issues, hormonal imbalances

Unhealthy Interest in Non-Surgical Solutions:

Check all that apply

Additional Comments:

We need to make sure your state allows telehealth.
If you live far, we do offer virtual consultations