LaserCap Patient Feedback How long have you used LaserCap? (in months)*Who is your hair restoration physician?*What is your Zip Code*What is your Age*What is your Gender?*FemaleMaleWhat other treatments have your tried? (click each treatment while holding <ctrl> key )*Transplant - give detail in 'other' belowPRP - give detail in 'other' belowTopical Minoxidil or RogaineOral Minoxidil (off-label)Oral Finasteride or PropeciaTopical Finasteride (off-label)Saw Palmetto e.g., Nutrafol, specify in 'other' belowMarine Collagen e.g., Viviscal, specify in 'other' belowBiotin or other supplements, specify in 'other' belowMedicated Shampoo, e.g., Nioxin, specifiy in 'other' belowScalp micropigmentation (cosmetic)PDO threads (off-label)Other off-label treatments, specify in 'other' belowOther Treatments and/or details of above treatments (or "none")*What was the overall clinical effect? (slow/stop/reverse thinning)*Do you have any other comments, questions, or concerns? (or "none")*Optional Fields - please complete to follow up with Dr. Rabin, LaserCap Inventor, to discuss your case.Name First Last PhoneEmail Please Provide Top-of-Head Photo This iframe contains the logic required to handle Ajax powered Gravity Forms.