Pre-Consultation - Angel Trichology

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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:

GP SURGERY & NAME OF GP

Hair scalp concern

List medication

List supplements

Surgical procedure (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

Get the hair that you deserve

Book your consultation today

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Opening Hours:
Monday – Friday 9am – 5:30pm

Phone: 078173 22235
Email: [email protected]

Address: Main Street, Kilby Wigston, LE18 3TD

Copyright © 2023 Angel Hair Trichology. All Rights Reserved.

Home
About us
What is Trichology?
Hair & Scalp Conditions
Pre-Consultation
Consent Form
Consultation
Treatments
Pricing

Home
About us
What is Trichology?
Hair & Scalp Conditions
Pre-Consultation
Consent Form
Consultation
Treatments
Pricing

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