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Complete this form and receive a free evaluation from our surgeon.
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Please select your gender.
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Gender
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Select your frontal hair loss
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Frontal Hair Loss
Select your crown hair loss
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Crown hair loss
Select your hair loss level
*
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What is your hair color?
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Hair Color
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What is your hair type?
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Hair Type
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How long have you been experiencing hair loss?
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Select an option
1 year or less
2 years
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years or more
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Have you ever had a hair transplantation?
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Had a hair transplantation before
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List all previous hair transplantation surgeries
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Have you ever got scalp micropigmentation?
*
had micropigmentation before
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List all previous micropigmentation sessions
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Do you have time to send us photos of your head now?
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Can Send Photos
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Please send pictures of your head taken from the following angles.
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Preferred Language
English
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Surgery location (city)
Miami FL
Dallas TX
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