Virtual Hair Restoration Consultation

* indicates required field!

1. Contact Information


2. Please select photos of your hair loss patterns:*

Norwood 2 Norwood 2a Norwood 3 Norwood 3a Norwood Vertex Norwood 4 Norwood 4a Norwood 5 Norwood 5a Norwood 6 Ludwig 1 Ludwig 2 Ludwig 3 

3. Which therapies have you tried? (check all that apply)*

Propecia/Finasteride Rogaine/Minoxidil Laser/LLLT Hair Transplantation Natural Herbs/Supplements Shampoos/Topicals Other 

4. Your Hair Restoration Goals (check all that apply)*

Hairline Restoration Increased Density Crown Coverage Stop/Slow Hairloss Other 

5. Timeframe in which to proceed:*


6. Questions/Comments:

7. Upload Photos (max 1mb):