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* Any family history of baldness or thinning hair?	Yes No I don’t know
* Did baldness or thinning hair come about rather suddenly?	Yes No
* What is your time frame to proceed?	I’m ready to proceed now. I hope to do something soon. I’m evaluating various options. I’m just curious.
* Will you require financing assistance?	Yes No I don’t know
* I'd like an appointment for a free consultation	Yes No
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