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

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before
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Click here to view 'before & after' hair transplant photos.
 
How Can You Beat Hair LossWhy 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

1.
Your Age Gender
 
2. Your natural hair colour is?
3. Which best describes the texture of your hair?
Straight Curly
Wavy  
 
4. What is the texture of your hair at the back and side of your scalp?
Fine Thick
Medium  
 
5. 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
6. Any additional information about your hair loss?  
7. At what age did you notice your hair loss?
under 20 21 - 30 31 - 40
41 - 50 over 50  
 
8. What are your expectations from hair transplantation (restore the front hairline, mid scalp, back or your entire balding area)?  
9. 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.
 
* Title :
* First Name :
* Last Name :
* Email :
  Day Phone :
  Evening Phone :
(including country and area codes)
  I prefer to be contacted :
* Address :
* Suburb :
* State  
* Postcode :
* Country :
  I prefer to be contacted by :
Please write the letters you see in the image in the box provided.
* :
 
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