We offer several options for you to obtain a free, no-obligation consultation regarding your hair loss. We will determine whether you are a suitable candidate for Hair Transplantation Surgery and provide you with a personalized hair restoration plan.
If you can come to our clinic in person, we invite you to schedule an appointment for a free, no-obligation personal consultation by calling the numbers below:
For a fast and easy online evaluation you will need to fill out our form. If you desire we recommend you attach digital photographs or scanned copies of print photographs. All of your personal information is private and confidential. All fields marked * are required.
Age*:
Sex*:
Male
Female
Hair Colour:
Hair Texture(Type):
Curl / Waviness:
Looking at the classification, which situation best describes your hairloss?
Baldness Pattern for men*:
1
4
1
4A
2A
5
3
5A
3A
6
3 Vertex
7
Baldness Pattern for women*:
Grade 1
Grade 2
Grade 3
Is there a family history of hairloss?
Yes
No
Brief family hair loss history:
At what age did you begin to experience hair loss?
Brief personal hair loss history:
Are you presently taking Finasteride (Propecia)? If yes, for how long?
Are you presently taking Minoxidil (Regaine)? If yes, for how long?
Have you ever had surgical hair restoration performed?
Yes
No
For us to provide you with a more informed reply please attach photographs with the following views. These photographs will be kept private and confidential.
Examples of pictures needed
It is not necessary that all photos be close-ups. . A distance of between 1 to 2 metres with the entire scalp in framed focus is sufficient. The use of flash is not necessary in fact it is recommendable to have bright room lighting available instead. To determine the correct location of your hairline, please ensure that your whole face is visible and have your hair combed back. If there is no hairline present try to draw your own hairline to show us where you would like to have it placed. This helps us better understand what you expect to accomplish with a hair transplantation procedure.
Comments:
Contact Details
First Name*:
Last Name*:
E-mail*:
Phone Number:
Mobile Phone Number:
Adress:
City:
Province / State:
Zip Code:
Country:
How do you prefer to be contacted?
Please let us know when it is most convenient for you to be contacted
Prefered Date:
Prefered Time:
By Mail
Even if you do not have access to a digital camera or scanner you can receive a complimentary evaluation simply by sending us print photographs at the address below.
Examples of pictures needed
It is not necessary that all photos be close-ups. . A distance of between 1 to 2 metres with the entire scalp in framed focus is sufficient. The use of flash is not necessary in fact it is recommendable to have bright room lighting available instead. To determine the correct location of your hairline, please ensure that your whole face is visible and have your hair combed back. If there is no hairline present try to draw your own hairline to show us where you would like to have it placed. This helps us better understand what you expect to accomplish with a hair transplantation procedure.
Tel: 0800 1 480 280
in der Wilhelmstraße 2-4 | 58332 Schwelm