Online consultation request
your contact details:
Name
 *
Surname
Email
 *
Cellphone
 *
Phone
City
Country
Gender
 male
female
     
Your hair situation
Age
 *
Your hairloss began at age:
 *
     
If you had previous hair surgery, write your first surgery details here(date, technique, and graft number if you have the data)
Same if you had a second hair surgery
     
Present hairloss status
 *
     
Please select on the norwood/ludwig scale the hair situation you fell is closest to your present status
*
   

<Norwood scale>

<ludwig scale>
Nature of your hair:
Thickness of your hair
If using a hair treatment please select the one you are using
 none
minoxidil 2%
minoxidil 5%
finasteride 1mg (propecia)
finasteride 5mg(proscar)
dutasteride(avodart)
saw palmetto
mesotherapie
     
Surgery preferences
If you are considering hair transplant, which procedure are you most interrested in?
     
You are specifically looking for (select at least one):
informations on medical treatments
informations on surgical treatment (hair transplant)
invoice for hair transplant
     
You are specifically interrested in our clinic of
     
We can provide you with these options, please select the ones you would like

photo&email estimation
webcam consultation
phonemeeting
direct office consultation in Paris, London or Abu Dabhi
You prefer that we reply to you using:
     
Which one of these options you feel would help you better understand hair transplant:
 meet a patient
talk to a patient
see a surgery
in-depth consultation
     
Describe your goals here
 *
You have heard from us through:
     
Enter a pictures facing forward (2 Mo maximum)
Enter a picture of the top of your skull (2 Mo maximum)
Enter a picture from the sides (2 Mo maximum)
Enter a picture of you donor area (2 Mo maximum)
     
 

HAIRLOSS NEWS


      • All the news by cliqking here
      • Dr Emorane Lupanzula will offer consultation in Paris and London on June 26 [25.05.10]

        <dr Emorane Lupanzula> Dr Lupanzula practices FUT, FUE and BHT in his bruxelles clinic.Contact us to meet him in person in London or Paris.

         

        • New partnership with Doctor Jeffrey Epstein [30.11.09]

          <la garantie Hairmed>

          Hairmed is very proud to annouce it's new partnership with the reknown Doctor Jeffrey Epstein from Miami. Dr Epstein is a mamber of the International Alliance of Hair Restoration Surgeons Read the article

        • FUE is now perfect! [27.10.09]

          <dr Patrick Mwamba>With FIT unshaven, our Bruxelles team no longuer needs to shave the patient to perform state of the art FUE Contact us to get an FUE without having to shave !

We recommend: <HairDx TEst>

 

<FUE / FIT>