QUESTIONNAIRE

Name and surname

Date of birth

Email address

Phone number

Gender
WomanMan

Hair color

Hair type
SimpleWavyCurly

Which Norwood image suits your hair loss status?
IIIIIIIVVVIVII

How does the balding process in the family (father, grandparents) follow the Norwood scale?

What medicines did you take to stop hair loss?

The first place of hair loss?

Have you ever had a hair transplant?

Additional information

Please attach photos in the following shots:






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