DoctorSelect DoctorDr. Nitin Barde
SpecialitySelect SpecialityHair Transplant
Date of Birth
Name of Spouse
For how long have you been suffering from hair loss(in Months)?
Is it continuous or intermittent?ContinuousIntermittent
How much hair do you lose per day?
Do you have any skin allergy?
How are you presently dealing with your hair loss?(Current Treatment)OilShampooSolutionTabletsAyurvedicHomeopathyNone
Do you Suffer from any of the skin disorder?PsoriasisDandruffItchingNone
Family History who suffered hair loss?FatherBrotherUncle (Paternal)Grandfather (Paternal)MotherSisterUncle (Maternal)Grandfather (Maternal)Other
What do you think has caused your hair loss?
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