Hair Loss History

What are your overall goals and objectives with your hair restoration procedures?

FUE FUT Eyebrow Restoration PRP treatment Facial Hair Restoration Unsure

Select the zones on your scalp you want to have treated

(Proceed to next question if you are not seeking scalp hair restoration)

Have you consulted with another hair transplant doctor? Please select Yes No

When are you thinking of scheduling your hair restoration procedure? Please select Less than 1 month 1-3 Months 3-6 Months 6-12 Months Not Sure