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Hair Transplant Assessment
What is your age?
18-25 years old
26-35 years old
36-45 years old
46+ years old
What best describes your hair loss pattern?
Receding hairline at temples
Thinning at the crown/top
Both hairline and crown
Overall thinning everywhere
Patchy hair loss
How long have you been experiencing hair loss?
Less than 1 year
1-3 years
3-5 years
5-10 years
More than 10 years
Do you have a family history of hair loss?
Yes, on father's side
Yes, on mother's side
Yes, on both sides
No family history
Not sure
What are your main goals for hair restoration?
Restore natural hairline
Increase overall density
Fill in crown area
Boost confidence
Look more youthful
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