Consultation form

We'll let you know:

If you're a candidate for hair transplant surgery
Whether your goals can be realistically attained
An estimate of the number of grafts required to achieve your goals
An estimate of cost for the procedure

To help us provide an accurate estimate we ask you to send us your contact information, transplant history and pictures of your hair loss and donor area. We will handle your personal information with delicate care and respect for your privacy.

Fields marked with an asterisk (*) are required

1 Personal information

Select your language

Salutation

First name

Last name

Street

Number

Postal code

City

Country

Date of birth

Profession

Phone number

How were you introduced to Dr. Feriduni and his clinic?

Google

Website

Online forum

Word-to-mouth

Hair dresser

Other

In which treatment(s) are you interested?

Hair transplantation

Beard / moustache transplant

Eyelash transplant

Eyebrow transplant

SHA-lift (high forehead)

Repair after a former hair transplant

Scar correction

Medical therapy

Other

2 Your hair

Hair type

European

African

Asian

3 Hair loss

Do you suffer from hair loss?

Yes

No (go to question 4)

Is there a family history of hair loss?

Yes, mother's side

Yes, father's side

Yes, both

At what age did you start suffering from hair loss?

Duration of your hair loss

weeks

months

years

Which areas are affected by hair loss?

Which technique would you prefer?

FUE

FUT

BHT

I don't know

Are you currently taking medication to prevent your hair loss?

Finasteride

Minoxidil

Dutasteride

Rogaine

None

Other

Have you consulted any professional about your hair loss?

Yes

If "yes", what was your diagnosis?

Have you undergone a former hair transplant?

Yes

If "Yes", please indicate the date you had the surgery, technique, clinic's name, number of FU and your opinion about the obtained result

What are your hair transplant goals and what would you like to achieve?

4 Pictures

To give Dr. Feriduni an accurate perspective of your actual hair situation, we kindly ask you to send in good quality pictures according to our photo guidelines:

A picture of the hairline

Allowed file types: GIF, JPG, PNG

A picture of the top of the scalp

Allowed file types: GIF, JPG, PNG

A picture of the right or left profile

Allowed file types: GIF, JPG, PNG

A picture of the donor area

Allowed file types: GIF, JPG, PNG

Is there any extra information you need to share with us?

Please do understand that the purpose of this consultation form is to gain information, it can on no account replace a live consultation.

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