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Hair Transplant-Follicular Units
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Body Hair Transplant
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Consent To Hair Transplant Surgery
Instructions For Hairtrans-Plant
Procedures | Hair |
Online Consultation Form
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How did you first learn of Dr. Krishna S Chaudhari?
1. How long have you been losing your hair?
1-3 years
3-7 years
7-15 years
more than 15 years
2. Stage at which the hair loss reached?
Male
(1)
(2)
(2v)
(3)
(3v)
(4)
(4a)
(5)
(5a)
(6)
(7)
3. Family history of Baldness
Yes
No
4. Any major illnesses in past or present
5. Is the hair growing on the sides of your head? (Choose one)
Thin and full
Thick and full
Thin and slightly receding
6. How would you rate your current rate of hair loss? (Choose one)
Light
Moderate
Heavy
7. Have you ever seen a doctor about your hair loss?
Yes
No
8. Why do you want to do anything about your hair?
I look older than I feel
I hate the way my hair looks
I want to meet younger men/women
People make fun of me
Comments:
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We would be happy to discuss hair transplantation with you after receiving a note and photographs by mail.
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