National Hair Institute, Follicular Hair Transplantation & Restoration, Hair Loss Solution, Melbourne, Sydney, Australia

National Hair Institute
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Call Us: (03) 9699 7733

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ERKAN'S VIDEO DIARY
The Procedure

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

click here to play video »

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Online Consultation

Online Consultation


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. Over the last 12 months I would describe my hair loss as
 
* 5. Have you ever seen a doctor / dermatologist regarding your hair loss?  
  If so, with whom?  
 
* 6. Are you currently using or have you ever used any of the following?:
  If Yes, since when and how long?  
Additional Comments (optional)  
 
* 7. If considering hair transplantation, which ONE of these best explains your goal:
Add more information if needed  
 
  8. List any allergies  
 
* 9. How unhappy are you about your hair loss?







 
 
* 10. 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
Hair I-1
   Hair I-2
Hair I-3
   Hair I-4
Hair II-1
   Hair II-2
Hair III
   Advanced
Hair Loss Type Frontal

      
  11. Is there any additional information that is relevant to your hair loss?  
* 12. How did you hear about us?
 
Should you have any further comments?  
 
 
 
Please write the letters you see in the image in the box provided.
* :
 
 
We take every available step to ensure that our estimation is as precise as possible.
As this is an online assessment, the accuracy of this graft number will not replicate that of a face to face consultation.
National Hair Institute, Sydney, Australia
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