Online Hair Loss Consultation Form

Streamline Your Virtual Hair Loss Consultations with Paperform

Hair loss consultations require detailed patient information, visual assessments, and thorough medical histories—all before the first appointment even begins. Our Online Hair Loss Consultation Form brings together everything healthcare providers, dermatologists, and telehealth specialists need in one professional, easy-to-complete experience.

Built for modern telehealth practices

This template helps you collect progression timeline photos, family history assessments, hormonal screening results, and lifestyle factors in a structured way. Patients can upload multiple images showing different angles and timeframes, answer conditional questions based on their hair loss pattern, and share relevant test results—all from the comfort of home.

The form adapts based on patient responses using conditional logic, ensuring you only ask relevant follow-up questions. If someone indicates they have recent lab results, additional fields appear for uploading documents. If they're experiencing sudden hair loss, specific screening questions trigger automatically.

Save time and improve outcomes

By gathering comprehensive information before the consultation, you can spend video appointments discussing treatment options rather than collecting basic data. The form includes sections for comparing treatment preferences, budget considerations, and lifestyle factors that influence treatment success.

Automate your workflow with Stepper: Connect this form to Stepper to automatically route new consultations to the right specialist, create patient files in your practice management system, flag urgent cases, and send pre-appointment instructions based on the patient's specific hair loss type.

Add secure documentation with Papersign: After consultation, use Papersign to send treatment consent forms, HIPAA authorization documents, or prescription agreements for eSignature—keeping everything connected to the original consultation for complete record-keeping.

Professional, patient-friendly experience

The form is designed to feel reassuring and professional, not clinical and cold. Clear instructions guide patients through each section, from taking proper progression photos to understanding which family members to include in their history. The clean interface works perfectly on mobile, so patients can complete it wherever they're comfortable.

With Paperform's SOC 2 Type II compliance and secure data handling, you can confidently collect sensitive health information and photos. Submissions can integrate directly with your EHR system, CRM, or telehealth platform via native integrations or webhooks.

Trusted by dermatologists, hair restoration clinics, telehealth platforms, and wellness practices, this template helps you deliver thorough virtual consultations while reducing administrative burden on your team.