Hair & Scalp Consultation

5. When did you first notice the problem? *

6. Where is the main concern? *

7. Did the problem appear suddenly or gradually? *

SuddenlyGraduallyNot sure

8. Have you noticed increased hair shedding? *

YesNoNot sure

9. Do you have any scalp symptoms?

10. Is there a family history of hair loss? *

YesNoNot sure

11. Recent stress, illness, surgery, pregnancy or major weight change?

12. Medications or chronic health conditions?

13. How often do you wash your hair? *

14. What are your main concerns and goals? *

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