Appointment Title *---Mr.Mrs. 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
