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  • Email address

  • Name

  • Age

  • City of Residence

  • Gender

  • Hair Condition

  • Scalp Condition

  • Hair Density

  • Hair Texture

  • Hair type

  • Diagnostic Tests (if already done)

  • Are you experiencing severe Hair Fall?

  • Male/Female

  • Hair Loss Area

  • Grey Hair

  • Genetic history of hair loss?

  • Any Medical condition?

  • Hair treatment done previously?

  • Skin & scalp disease?

  • Consumption of protein powder

  • Shakes

  • Injections

  • Smoking

  • Excessive drinking

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hair fall treatment