Hair Form

DoctorSelect DoctorDr. Nitin Barde

SpecialitySelect SpecialityHair Transplant

First Name

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GenderSelect GenderMaleFemaleOther

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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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