ONLINE CONSULTATION FORM

Welcome to our free online hair transplant consultation form.  Please complete all of the details below and upload your photographs so that we may be able to contact you with details of suitable treatment options.  We will also provide you with a quote for the cost of the treatment options.  Should you wish to find out more we will then make an appointment for you to meet one of our surgeons.

First Name (required)

Surname (required)

Contact Number (required)

Your Email (required)

Age (required)

Address (optional)

City (optional)

Postcode (optional)

At what age did your hair loss start? (required)

Is the hair loss stable now? (required)

Do you currently use any hair loss treatments? (required)

If yes, what do you use?

Have you previously had hair transplant surgery? (required)

If yes, when was this and what procedure did you have?

Using the Norwood scale

How would you class your hair loss pattern? (required)

How would you describe your skin colour? (required)

What is your hair colour? (required)

How would you describe your hair quality? (required)

Please upload up to 4 pictures in the following format (Supported file formats include JPG, JPEG, GIF & PNG with 2MB file size limit per image):

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Add file

How did you hear about Skin and Follicle? (optional)

If other, please specify

 ARTAS ROBOTIC HAIR TRANSPLANTS NOW AVAILABLE IN THE MIDLANDS

SEE THE DIFFERENCE

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