2).If yes, please choose the closest options (multiple options are permitted):
How long have you suffered with hair loss or thinning?
Estimate the number of hair that you currently lose
Describe the texture of your hair
If Yes, how much?
Is your general health and fitness
Please detail on the previous answer as elaborately as possible
Please specify the treatment(s), if any that you have taken or undergone for hair or scalp problem
If you have any extra comments about your hairloss or scalp problem please inform us in the space provided