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About You
Hair Health
Internal Health
Scalp Assessment
Personal Info
Before We start can, we get Know about yourself ?
Name
Phone/Mobile
Age
Gender
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Male
Female
Others
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Hair Health
Lets Talk about Your Current Hair Health !
Do you have dandruff?
Yes
No
Do you consume tobacco or alcohol?
Yes
No
Is your scalp oily?
Yes
No
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Internal Health
Answer Some Serious Questions Related To Your Health!
Do you have blood pressure problems?
Yes
No
Do you have a thyroid disorder?
Yes
No
Do you experience constipation?
Yes
No
Are you diabetic?
Yes
No
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Scalp Assessment
Let Us Know Current Condition Of Your Scalp!
Do you have a family history of hair loss?
Yes
No
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