• Virtual Consultation Form

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  • Medical History

  • Congestive heart failure, irregular heartbeat, coronary artery disease are all cardiac issues that may require permission from a cardiologist before treatment, especially if you are going to use a higher strength minoxidil. Minoxidil was originally used to lower blood pressure, and as a side effect was found to help hair growth. It is a linear does drug so the higher the strength the better it works.

    Anemia and Thyroid disease (hypothyroid and hypothyroid) may cause hair loss.

    Diabetes - diabetics usually take longer to heal and if not controlled, may also cause poor circulation.

    Depression and liver disease affect general health and medications given to treat these conditions may cause hair loss.

  • Many medications may cause hair loss as a side effect. The most common are anti-coagulants such as heparin, warfarin (Coumadin), Antidepressants, hormones (birth control as well as HRT), some thyroid medications, and statins (cholesterol lowering drugs). CLIENT SHOULD NEVER STOP MEDICATIONS WITHOUT CONSULTING THEIR DOCTOR.

  • Females Only

  • Males Only

  • Men who have enlarged prostates or are being checked (PSA) for enlarged prostate, need to let their doctor know they are taking an "anti-androgen (saw palmetto) (XTC Supplements) or "Propecia/Finasteride) as they may cause the PSA to have a lower value than it really is.

    The doctor may suggest you discontinue taking the supplement for a week or two, prior to having this test performed; for a more accurate reading of their level.

     

  • Nutrition

  • Diet is very important for healthy hair. Adequate protein intake is essential. How much a person needs is based on body weight at .8g per kilogram (2.2 lbs). The only contradiction on this is a person who needs to restrict protein intake such as someone with kidney disease. 

    Vegetarians who do not eat any kind of animal protein will have a difficult time with adequate protein as there are two types of protein - complete (animal based such as meat, fish, and poultry which includes dairy products and eggs) and incomplete (nuts, legumes, soy, etc)

    Fruits and vegetables are important and people should eat a variety of colors for the best nutritional value. Caffeine (coffee, tea, colas, chocolate, energy drinks) interferes with how your body processes B vitamins so excessive use should be avoided.

    Anyone who has lost a lot of weight in a short period of time (diet, gastric bypass or bariatric surgery) will lose hair. 

     

  • Conditions of Hair and Scalp

  • Some of this information you will notice when you examine the scalp. Dandruff may be a sign of an allergic reaction or an excessively dry scalp.

    Redness, bumps, raised areas or itching may be a sign of an infection (bacterial or fungal) as well as insect bites or more serious problems such as melanoma. Any raised rash, scaly areas (raised white scaly areas may be psoriasis) or open cuts/wounds should be referred to their physician or a dermatologist. Patchy areas on the scalp, eyebrow, facial hair (men), may be alopecia areata. This is usually a sudden hair loss that may progress to totalis (all the scalp hair) or universalis (all body hair). It may only be an allergic reaction but the cause is not really understood. Hair loss may be a symptom of a disease such as lupus and I usually recommend that people with alopecia areata see their doctor to rule out serious autoimmune disease.

    Another cause of patchy loss would be scarring alopecia. This is usually seen as a red area that may have some drainage. When it heals, it is very smooth with no hair. A diagnosis of scaring alopecia is usually done by biopsy of the area by a dermatologist. There are no follicles in the scarred areas and regrowth is not possible. The hairs around these areas may be strengthened with treatment and may make these areas easier to hide with other hair.

    There may also be chemicals (perms, strong chemicals) or physical scaring (heat, accident) where regrowth may not be possible.

    Occasionally a person with Trichotillomania will come for treatment. These people pull out their hair, eyebrows, eyelashes and may benefit from counseling to find out the cause of this abusive type of behavior. If they continue to pull out their hair, the loss may become permanent. 

  • Some hair loss is normal. Normally approximately 10% of the hair is in the growth stage and a person may lost 50 to 100 hairs daily and still be considered normal. It is when people see hair all over their pillow, sink, and clothes that there is a real concern and they seek treatment. People like animals, do occasionally shed and is not cause for alarm as long as they are replacing those hairs which would be visible with the capilloscope.

     

  • Wet hair is more vulnerable and thin, weak hair may be damaged when vigorous rubbed.

  • Heredity

  • If someone indicates they have no family history of hair loss, ask how far back they are going. Hair loss may skip a generation and is carried on several genes so it may randomly show up in family members or carry down from generation to generation on a regular basis.




  • Consent for treatment

  • I am being evaluated at ________________________ and understand I will first undergo a comprehensive preliminary evaluation by one of our experienced thinning hair consultants. This evaluation will determine if I am a suitable candidate and I understand the cost of the initial evaluation is __________. All other follow up and scalp analysis, questionnaire, and scalp evaluation including standard photography (no face seen), and microscopic photography. Further evaluation will consist of monthly or quarterly digital and capilloscope pictures for which I give my consent for all of the above. I further understand that each person is different and like any treatment, results will vary depending on a large number of factors. I acknowledge that it is my responsibility to inform the company of any changes in my condition; no matter how slight.

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