Free Evaluation of Your Hair Loss

Fill out the form below, using the hair loss charts to the right to reference your current balding pattern as well as that of your mother and father (family history helps to determine a pattern). Please also let us know if you wish to be contacted via phone or
e-mail by choosing a preference below.

Or Call 800-694-4247 to Schedule a Consultation

Evaluation Form

* Denotes a Required Field

Personal History

Family History




  Please call me to schedule a private consultation
  Please send me more information via e-mail



Male Hair Loss Chart

Male Hair Loss Chart

Female Hair Loss Chart

Female Hair Loss Chart