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Virtual Hair Restoration Consultation

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    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):

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      * 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):

      Instructions: Please follow these examples for the angles of your head needed for evaluation. Each photo should NOT exceed 5 mb due to a limitation in the combined size of all images(there will be a warning if a file exceeds 5 mb.). All submitted images and information will be kept confidential, not be used or sold by any third parties, nor be broadcast publicly.

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      Angle 3


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