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

Erken 5900
Click HERE to see Erken 5900 Grafts(approx 11000 hairs) in one procedure
read more...

Jim 4042
Click HERE to see Jim 4042 Grafts(approx 8700 hairs)in one procedure
read more...


Click here to view 'before & after' hair transplant photos.

Why am I losing my hair?

Can my hair loss be slowed or stopped altogether?

What is the best solution for my current state of hair loss?

This book answers these important questions and more. It is essential reading for anyone considering doing something about their hair loss.

Virtual Consultation

Your Hair Loss Evaluation

Your Age

Gender

Your natural hair colour is?

Black/Dark Brown	Medium Brown
Grey	Light Brown/Blond/Red

Which best describes the texture of your hair?

Straight	Curly
Wavy

What is the texture of your hair at the back and side of your scalp?

Fine	Thick
Medium

Choose the image that best describes your hair loss

	Hair Loss Type II			Hair Loss Type IV
	Hair Loss Type IIa			Hair Loss Type IVa
	Hair Loss Type III			Hair Loss Type V
	Hair Loss Type IIIa			Hair Loss Type Va
	Hair Loss Type III vertex			Hair Loss Type VI

Any additional information about your hair loss?

At what age did you notice your hair loss?

under 20	21 - 30	31 - 40
41 - 50	over 50

What are your expectations from hair transplantation (restore the front hairline, mid scalp, back or your entire balding area)?

Have you consulted with a doctor/ trichologist about your hair loss condition?

Yes No

With whom?

10.

Were you recommended any treatment for your hair loss?

11.

Have you had a hair procedure before?

Yes No

If so, with whom?

12.

Have you used any of these oral & topical medications for your hair loss?

Rogaine	Past	Present
Saw Palmetto	Past	Present
Propecia	Past	Present
Other	Past	Present

13.

Has your hair loss had an effect on your life, if so in what way?

14.

Has your father suffered a significant amount of hair loss?**

Yes No

15.

Has your mothers, brothers suffered a significant amount of hair loss?**

Yes No

16.

Has your brother suffered hair loss?**

Yes No

** No answer is required if these questions are not applicable

Your Contact Information

Note: This form and any reply to it does not take the place of an actual in person consultation. It is merely intended to provide us with an initial idea of your condition and goals. With this information we can then give you an informed reply.

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