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Hair
How long have have you been losing your hair?
How long have have you been losing hair?

Is it Seasonal or Permanent
Is it seasonal or permanent
- Seasonal
- Permanent

Personal Details
Name*
First Last
Age*
Sex*
- Male
- Female

Email*
Phone*
Country*

Do you get medical treatment ? (Minoxidil, Propecia…)*
Have you ever had surgery on your hair before?
What do you expect?

Please send us some pictures of your hair
Upload your pictures here.
Drop files here or
-A picture of the area where hair loss is observed
-A picture of the back of your hair
-A picture of the head bent forward to see the front line
- A picture of the head tilted back to see the top of the scalp
Pictures have to be sharp and clear. Use natural light instead of flash for better quality.