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How did you first learn of Dr. Krishna S Chaudhari? *

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How long have you been losing your hair?

Stage at which the hair loss reached?

Family history of Baldness

Any major illnesses in past or present

Is the hair growing on the sides of your head? (Choose one)

How would you rate your current rate of hair loss? (Choose one)

Have you ever seen a doctor about your hair loss?

Why do you want to do anything about your hair?


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We would be happy to discuss hair transplantation with you after receiving a note and photographs by mail.