National Hair Institute, Follicular Hair Transplantation & Restoration, Hair Loss Solution, Melbourne, Sydney, Australia
National Hair Institute
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ERKAN'S VIDEO DIARY
The Procedure

See Erkan's 5944 grafts (approx 11,000 hairs) in one procedure

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National Hair Institute

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Your Hair Loss Evaluation
 
* First Name  
* Surname  
* Mailing Address  
* Postcode  
  Contact Number (Mob)  
  Contact Number (Bus. Hrs)  
* Email  
* Occupation  
Date of Birth  
Gender
 
 
* 1. Which of the following represents the reason you are contacting NHI:
 
* 2. Are any members of your family affected by hair loss?
 
* 3. How long ago did you first realize that you were losing your hair?
 
* 4. Have you ever seen a doctor / dermatologist regarding your hair loss?  
  If so, with whom?  
 
* 5. Are you currently using or have you ever used any of the following?:
  If Yes, since when and how long?  
Additional Comments (optional)  
 
* 6. If considering hair transplantation, which ONE of these best explains your goal:
 
  7. List any allergies  
 
* 8. How unhappy are you about your hair loss?







 
 
* 9. Choose the image that best describes your hair loss
Hair II
   Hair IV

Hair IIA
  
Hair IVA
Hair III
 
Hair V
Hair IIIA
 
Hair VA
Hair III Vertex
 
Hair VI
  10. Is there any additional information that is relevant to your hair loss?  
* 11. How did you hear about us?
 
Should you have any further comments?  
 
 
 
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National Hair Institute, Sydney, Australia
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