Hair Transplantation Techniques

Free Online Consultation

Please spare a few minutes to answer the following questions.    To fix the type of your hair loss, and to give you information about the possible cost of the treatment, we need correct information in the required spaces in the form.

For a healthy diagnosis, you should see the doctor in person. If you send three photographs taken from different angles showing the current state of your hair, our experts will contact you. The size of your photographs sent via e-mail shouldn't exceed 200KB; otherwise; we won't receive the photos you have uploaded.
 
 
* First Name :  
* Last Name :  
* E-Mail :    
  Address :
* Country :  
  City :
  State / Province :
  Zip Code (eg. 12345) :  
* Day Phone (eg. (555) 123-3450 ) :    
* Mobile Phone (eg. (555) 123-3450 ) :    
  Profession :
* Date of Birth :  
* Sex :
 
  Texture of hair :
  Waviness of hair :
  Hair Colour :
      1. Family history of baldness-hair loss
     
       
*     2. Baldness pattern
     
 
     
       
      3. Which tecnique are you interested in?
     
       
      4. What would you like to achieve with hair transplantation?
     
       
      5. Have you had any previous surgery performed?
     
       
      6. Have you treated your hair loss with any of the following?
      Rogaine:

Propecia:

Diğer:
       
      7. Would you like to contact one of our former patients?
     
       
      8. Notes
     
      9. Please send some of your photos for better evaluation.
Please make sure the photos don't exceed 200 Kb each.
       
Photo1: 
Photo2: 
Photo3: 
       
      
       
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