1.Your
Self |
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Phone* |
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- Health (any major illness)
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2.Your
Hair/Scalp |
- How long since abnormal hair loss first noticed? *
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- How many hair strands fall daily (now)?*
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Any known bald patches?
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- Any medical diagnosis done?*
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- Any abnormalities on scalp?*
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3.Your
Diet |
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- High consumer of seafood?*
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- Consumption of water (no. of glasses/day)?*
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- Average food intake daily/mostly.*
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4.Your
Lifestyle |
- Do you work late (after 8.00PM)? *
(on an average)
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- Do you sleep late (after 1.00AM)?*
(more than 3 days a week)
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- Do you drink excessively (more than 3 pints of
beer/daily)?*
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- Do you smoke excessively?*
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- Does your work stress you up?*
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- Would you consider your family life as being
happy?
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