Free Consultation Application

Name

Phone

Height

Age

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

How did you hear about Hair Follicle

Preferred Method of Extraction

Have you had hair transplant surgery before?

Yes No

Previous Surgery Details
Please enter information for each of your past surgeries including: - Name of Doctor - Year of Surgery - Type of Surgery - Number of Grafts.

Have you used Propecia / Proscar / Finasteride?

Never Used Stopped using more than 2 months ago Stopped using less than 2 months ago due to side effects Stopped using within last 2 months Currently using, but not consistently Currently using as frequently as prescribed Using another medication such as Dutasteride

Have you used Rogaine / Regaine / Minoxidil?

Approximate date you would like to have your procedure?

Tell us your hair loss story:

Describe your restoration goals:

Upload Photo Instructions

Ensure the room is evenly lit and bright. This is best accomplished in the daytime using natural light.
Do not use a flash. It obscures the scalp. If you think you need a flash, you need a brighter room.

Please note the following:

Maximum file size: 5 MB per image, images must measure less than 3200px x 3200px.

FRONT Photo*

Drop Front files here or

FRONT Photo*

Drop Back files here or

What you need to know

Approximate duration: 3 minutes

We are usually able to review your submission and provide an assessment within 2-4 business days.

We’ll let you know:

If you’re a candidate for hair transplant surgery
Whether your goals can be realistically obtained
An estimate of the number of grafts required to achieve your goals
An estimate of cost for the procedure

Send Us Your Pictures
To help us provide an accurate estimate we ask you to send us your contact information, transplant history and pictures of your hair loss and donor area.

With more than 20 years of hair transplant surgery experience, the Hair Follicle Hair Transplant Clinic helps clients. Their consistently outstanding results and their groundbreaking work on the Lateral Slit Technique, mega-sessions, and FUT procedures have garnered them recognition on a global scale.

Useful Links

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