Dermatology Hair Loss Questionnaire

Form Template

This Dermatology Hair Loss Questionnaire Mobile App provides dermatologists' information on your hair loss issues and covers related issues like hair care, scalp disease, medical health, menstrual history, family history and treatment.

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Use this form template to improve quality of life when facing female pattern hair loss due to a hormone imbalance by finding the right hair loss treatment. Regardless of treatment type, receive useful information from board-certified dermatologists about skin and hair growth.

Use this app to help take control of hair thinning. Use this app to help mitigate alopecia concerns as relates to pattern hair loss or baldness. Understand what is happening with your hair follicles as relates to hair thinning. Adopt skin care practices, helpful habits, and learn about treatment options. Learn more about scalp health and hair growth when experiencing alopecia, such as alopecia areata, to improve quality of life.

A GoCanvas account can be specified as being HIPAA compliant. By turning on HIPAA compliance, a number of features that most of users find desirable will be disabled to meet HIPAA Standards. Individual apps in the GoCanvas Application Store can easily be made HIPAA Compliant. If you have any questions or need assistance you can contact our Sales team to help you at

If you would like to enable HIPAA on your GoCanvas account, please follow the instructions below:
1. Log onto your Account
2. Click “My Account” in the top right corner of the screen
3. Click “Customize” on the left
4. The third option is for HIPAA Compliance, click “Edit” on the right
5. Check the “Enable HIPAA Compliance” box and select “Save."

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