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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

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