3. What color is your hair?
Salt & pepper
4. What color is your skin?
5. Which best describes your natural hair?
6. What is the texture of your hair?
7. What is your ethnic background?
8. Select your baldness pattern (wet hair):
What does this mean?
Isolated Vertex Loss
Very Early Thinning
9. At what age did you begin to notice hair loss?
10. What are your hair restoration goals and what would you like to achieve for example: restore the front hairline, mid scalp, back, or your entire balding area with CIT, Strip or BHT)?
11. Have you consulted with a doctor about your hair loss condition?
Yes, i had a consultation
No, I never had a consultation
11a. What is the doctor's name who made your consultation?
11b. What treatment, if any, was recommended?
12. Have you ever had surgical hair restoration performed?
Yes, i had a surgery
No, i never had a surgery
12a. Who performed your surgery?
14. Do you have any medical issues?
Yes, i have a medical issue
No, i don't have a medical issue
I am on Pre-op Antibiotics
15. What is your family hair loss history?
16. Do you currently wear a hairpiece?
Yes, i wear a hairpiece
No, i don't wear a hairpiece
17. Please add any additional questions or comments:
Upload Your Photos
Please ensure you upload photos that are clear and capture all of the views shown in the examples below:
It is helpful if you rename the images to describe the angles.
(Example - "front.jpg" or "crown.jpg").
Please wet and comb your hair back for the front view photo.
Max upload= 32MB | Max upload file size= 5MB | File will be uploaded during submission
This form does not replace an actual in-person consultation. It is merely intended to provide us with an initial idea of your hair condition and hair restoration goals. With all of this information, we can provide you with an informed assessment and hair restoration plan.
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CIT AKA FIT
Female Hair Loss
How did you hear about us?
Salamaster ( Italian forum)