CONSULTATION ADVICE FORM - FEMALE ::: Hair Loss Help ::: www.groupofindependentdoctors.com
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Causes and Effects
Stages of hair loss
Consultation Advice Form
Stages of hair loss

Below are illustrated the four
stages of female hair loss.
To find out more, click here.


Stage 1


Stage 2


Stage 3


Frontal

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Personal Details
Name
EmailAgeSex
Male Female
At what age did
your hair loss start?
Does male hair loss run anywhere in your family? Do you have problems with your hormones?
Yes   No Yes   No
Has your hair loss stopped?

Yes   No

If so, for how long has your condition been stable?


Have you had a blood test recently?

Yes   No

Are you suffering from lack
of iron in your blood?

Yes   No
What stage of hair loss have you reached?
Stage 1      Stage 2      Stage 3      Frontal
Your hair loss
started when?
  After pregnancy?
  After the menopause?
  After shock (eg after major surgery)?
  After psychological stress?
  After medication?
  Other reason?
Is your hair straight or curly?
Straight      Slightly curly      Curly      Very curly
Please add any further information you think important
 
  
  
groupofindependentdoctors.com
Click here to go to Group of Independent Doctors Introduction page
The Group of Independent Doctors are all Plastic Surgeons based in Greece, a centre of excellence in the treatment of hair loss. You will be guaranteed personal, individual, discreet and confidential treatment by the doctor of your choice.
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To speak to a Consultation Manager in the UK
call 0845 6977230
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