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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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