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When did you first notice your hair thinning?
How would you rate the severity of your hair loss?
Where do you notice your hair loss? (select all that apply)
What do you believe might have triggered or contributed to your hair loss?
Are you open to the long term use of a pharmaceutical over-the-counter treatment (Minoxidil) on your scalp?
In addition to hair loss, are there other concerns you would like to address?
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