Hair Loss Questionnaire Pdf

Hair loss questionnaire. Hair loss generally falls into one of the following categories.

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Non invasive methods eg questionnaire daily hair counts standardized wash test 60 s hair count global.

Hair loss questionnaire pdf. Circle one better worse same. Patients were recruited from an alopecia support group and were assessed using the dermatology life quality index. The aim of this study was to quantify the effect of hair loss on quality of life.

Alopecia areata alopecia totalis alopecia universalis undiagnosed current past treatment date started date ended results. M or f date. How long have you had hair loss.

Questionnaire survey on hair loss questionnaire form ver. Which part of your head has hair loss. For other questions simply write your answers in the spaces provided.

Please share more about your hair loss condition by answering the following questions. For some questions you will need to mark the yes or no box at the right. Various methods are available for evaluation for diagnosis andor quantification of a patient presenting with hair loss.

All over front hairline crown back lower other 4. Circle areas where you have hair loss. Diffuse shedding is defined as having.

How rapid was the hair loss. For some questions you will need to mark the yes or no box at the right. Since that time how has your hair loss been.

Hair evaluation methods are grouped into three main categories. Request pdf on researchgate a hair growth questionnaire for use in the evaluation of therapeutic effects in men background. Hair loss questionnaire name.

You do not have to answer particular questions if you do not want to. There are some yesno answers and some questions require more detailed responses. Please choose the most appropriate response from among the options provided to answer the question.

This questionnaire can help you prepare for a conversation with your doctor about your alopecia areata symptoms and possibly participating in a clinical trial. Background of hair loss. Hair loss questionnaire if you have an appointment to be seen for hair loss please fill out the form and bring with you to your appointment.

Male pattern hair loss androgenetic alopecia is a common clinical. 12 for patients this questionnaire consists of a total of 14 pages in total. Hair loss questionnaire.

If you are experiencing diffuse shedding or diffuse thinning please complete part i. For other questions simply write your answers in the spaces provided. If you are experiencing hair loss in patches please skip to part ii on page 3.

Hair loss questionnaire please tell me more about your hair loss condition by answering the following questions.

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