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Hair Loss Questionaire

Let me start off by saying that I understand how personal all these questions and your answers are.  I want you to rest assured that they are for my eyes only and will not be shared with anyone.  Your answers to these questions will help me determine what type of hair loss you may be experiencing.  It will also help me determine what type of treatment and homecare products are needed to help either slow down your genetic hair loss or help grow back hair lost from stress, illness or nutrition issues. 

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