1Personal information

2Type of treatment

3Upload your photos

Name *

Age *

Phone *

Country *

City *

Email *

Correo electrónico

Confirmar el correo electrónico

Treatment areas *

Indicate, according to the graph, the areas of the head where you would like to restore your hair:

Indicate, according to the graph, the areas of the beard where you would like to restore your hair:

Indicate, according to the graph, the areas of the eyebrows where you would like to restore your hair:

Medical information

Hair Restoration

Have you ever had surgical hair restoration done? *

Do you have medical problems? *

In a few words tell us about your case, try to be as specific as possible. Only accounts with 300 characters maximum

It helps us if you rename the photos describing the angles from where they were taken (Example: front.jpg or superior.jpg).

Remember that you can upload a maximum of 6 photos with a weight of 4 MB each.

Photo front *