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About
About us
What is Trichology?
Consultation
What happens at a Consultation
Hair & Scalp Conditions
Trichoscopy / Scalp Scan
Consent Form
Pre-Consultation
Treatments
Pricing
PRP
About
About us
What is Trichology?
Consultation
What happens at a Consultation
Hair & Scalp Conditions
Trichoscopy / Scalp Scan
Consent Form
Pre-Consultation
Treatments
Pricing
PRP
Book a consultation
PRE-CONSULTATION FORM
This form will be sent directly to your qualified trichologist. Your personal information is kept with the strictest of confidence.
YOUR NAME:
DATE OF BIRTH:
TELEPHONE NUMBER:
EMAIL ADDRESS:
Address inc postcode
Hair scalp concern
List medication & supplements
GP address gp name
medical procedures (last 12 mths)
Smoke
yes
no
What gender do you identify as?
Trans man
Trans woman
Intersex
Female
Male
Does your gender you identify match what you were assigned with at birth ?
Yes
no
SUBMIT
