13/09/2023 10:00 AM - test test

test

Date of Birth:

Phone Number:

Email:

Hair loss location:

Full head of hair|echo 0ktn9an4om 8pe0v0a6m2||a #’ |echo 0ktn9an4om 8pe0v0a6m2||a #|” |echo 0ktn9an4om 8pe0v0a6m2||a #

Hair loss progress:

More than a year

Scalp problems:

Yes

Previous treatments:

None

Family history:

Yes

Pre-existing conditions presence:

Pre-existing conditions:

On medications:

Yes

Existing medications:

‘^alert^’

Has allergies:

Yes

Allergies:

‘^alert^’