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1 / 8
Patient Information
Are you 18-65 years old?
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2 / 8
Are you and your partner planning to get pregnant?
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3 / 8
Is your scalp healthy (no inflammation, redness, scabs, abnormal itching, excessive flaking)?
4 / 8
Medical History
Do you have a history of any of the following?
5 / 8
Could your hair loss be explained by any medication, dietary matter, or illness?
6 / 8
Are you taking recreational drugs?
7 / 8
Do you have any allergies to minoxidil, finasteride, dutasteride, or other medications of the same type?
8 / 8
Consent
Do you agree to the following?
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