We ask you to spare your time to answer the questions above. In order to determine your hair type, it is important that you fill the appropriate blanks in the form. Definite information about hair will be possible after medical inspection. If you can send us 3 different photos of yoor current hair taken from different angles, our specialists will get back to you soon. We’d like to remind you that e-mail size should not be larger than 200kbs, otherwise the documents won’t reach us.

Name- Surname
Address
City
Country
E-Mail
Phone
Sex	Male Female

Please mention if you have any permanent medication use.

Please mention if you have any diagnosed illness.

You can add the details and questions.

The amount of hair loss

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