Virtual Hair Restoration Consultation

* indicates required field!

1. Contact Information

 

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

Norwood 2Norwood 2aNorwood 3Norwood 3aNorwood VertexNorwood 4Norwood 4aNorwood 5Norwood 5aNorwood 6Ludwig 1Ludwig 2Ludwig 3

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

Propecia/FinasterideRogaine/MinoxidilLaser/LLLTHair TransplantationNatural Herbs/SupplementsShampoos/TopicalsOther

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

Hairline RestorationIncreased DensityCrown CoverageStop/Slow HairlossOther

5. Timeframe in which to proceed:*

 

6. Questions/Comments:

7. Upload Photos (Optional Max 5mb):

* indicates required field!

Contact Information

 

Help Us Understand Your Hair Loss

Please select photos of your hair loss patterns:*

Norwood 2Norwood 2aNorwood 3Norwood 3aNorwood VertexNorwood 4Norwood 4aNorwood 5Norwood 5aNorwood 6Ludwig 1Ludwig 2Ludwig 3

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

Propecia/FinasterideRogaine/MinoxidilLaser/LLLTHair TransplantationNatural Herbs/SupplementsShampoos/TopicalsOther

Your Hair Restoration Goals (check all that apply)*

Hairline RestorationIncreased DensityCrown CoverageStop/Slow HairlossOther

Timeframe in which to proceed:*

 

Questions/Comments:

Photo submission (Optional Max 5mb):

Instructions: Please follow these examples for the angles of your head needed for evaluation. All submitted images and information will be kept confidential, not be used or sold by any third parties, nor be broadcast publicly.

Angle 1


Angle 2


Angle 3


Follow us @drglenncharles
This error message is only visible to WordPress admins
This endpoint has been retired

Error: No posts found.

Make sure this account has posts available on instagram.com.

Contact Us
I agree to the Terms of Use*