FREE Treatment Evaluation for Women

We offer more than one type of treatment because different degrees and patterns of hair loss require different solutions. Complete our evaluation form and click the submit button. We will contact you with the best solutions suited to your hair condition.

Check the one image below that most closely resembles your current state of hair loss (check one only).

stage01
stage02
stage03
stage04
stage05

Diffused Hair Loss

Stage 1

Stage 2

Stage 3

Stage 4

Stage 5

frontal
traction
totalis
areata3

Frontal Hair Loss
Top & Front View

Traction Alopecia
Front & Side View

Alopecia Totalis
Front & Side View

Alopecia Areata
Front & Side View

1) Regarding the illustration you checked, how many years have you looked like this?

Comments (are there any details you'd
like us to know):

2) What is the texture of your hair?

Thick, curly

Thick, straight

Thin, curly

Thin, straight

3) Current age:

4) Age you started loosing your hair?

5) How much hair do you loose a day? (choose one)

20 hairs

20-50 hairs

over 50 hairs

6) Has the average number of hair you loose per day increased in the past 3 years? Yes No

*Asterisked items are required

First Name*

Last Name*

Phone*

Best time to contact you?

Street address*

City*

State*

ZIP*