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Hair transplantation (watch movies online!)

PRELIMINARY CONSULTATION VIA INTERNET

Your Last Name:		First:		Middle:
Country:		City:		Address:
e-mail:		phone number:
Your hair color?	black grey brown		light brown fair red
Describe your hair	straight wavy curly
What is your hair structure?	thin average thick
Indicate your degree of hair loss	( 1 ) ( 2 ) ( 4 ) ( 4 ) ( 6 )		( 1 ) ( 3 ) ( 4 ) ( 5 ) ( 7 )
At what age did you notice the first signs of hair loss?	before 20 21-30 31-40		41-50 after 50
Has the hair loss intensified in the last 5 years?	Yes		No
Is the growth line on your temples going down?	Yes		No
Do you suffer hair loss at the top of your head?	Yes		No
Are you losing hair only in the frontal zone?	Yes		No
Is your hair sparse over the entire horizontal surface of your head?	Yes		No
In which zone are you most interested in reconstructing hair?	Only the frontal The entire balding zone		Only the parietal
Have you ever consulted a trichologist?	Yes		No
Have you ever tried medical preparations? If yes, which ones?
Have you ever undergone surgical hair restoration?	Yes		No
Please note what you consider the most important points in the autotransplantation procedure. (in order of increasing importance from 1 to 6 )			123456	Temporary post-operational manifestations
			123456	Cost
			123456	Discomfort
			123456	Final result
			123456	Time of the procedure
			123456	Other
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Our address:
Moscow, 2-nd Tverskaya-Yamskaya st, 26.

Telephones:
+7 (495) 250 9656, +7 (495) 250 2991.

You can mail us to:
info@inteco-clinic.ru

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