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We take pride in providing each patient with an individual treatment plan. In order to obtain a quote, please provide photographs of the back of your head, both sides and the area affected with hair loss. Please ensure proper lighting.

Enter your data

Enter your data


* Required

Gender

Photo



Place of hair loss*


 Your file


Back of the head*


 Your file


Left side*


 Your file


Right side*


 Your file

* Max size of file 5MB





Send additional information

Type of hair loss

>

Male hair loss











Female hair loss




Hair type

>

Applied treatment

>



Oral anti-hair loss medications


Medicion for topical application to the scalp
Presently

Before

None





 

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