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Title *
Hair type *AfricanAsianEuropean
Hair structure *CurlyFineFrizzyMediumStraightThick
Hair color *BlackBlondBrownWhite
Is there a family history of hair loss *YesNo
Type of hair loss *Alopecia androgeneticaAlopecia cicatricalisDiffuse hair lossOther
Duration of your hair loss *MonthsWeeksYears
Which area(s) are affected by hair loss *DiffuseOn topComplete hair lineIndentationsBack of the scalp
technique *BothFollicular Unit Extraction (i.e. extraction of the units one per one)Follicular Unit Strip Transplantation
Are you presently treating your hair loss or did you already treat your hair loss in the past with one of the medications underneathfinasteridedutasterideRogaineMinoxidilNoneOther