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Name- Email (optional)- Male Female Age- Age when hairloss started- Brief description of your hair (Before treatment) Using a number betwhen 0 (Head without hair) and 100 (Head full of Hair), Describe your -before treatment- situation Description of your treatment (please include Concentration and other useful things) You've started the treatment Months ago -- Years ago Brief description of your hair now Using a number betwhen 0 (Head without hair) and 100 (Head full of Hair), Describe your situation now After how many months you've started notice results (If any)? Final comments (Include side effect ecc...)