CONSULTATION ADVICE FORM - MEN ::: Hair Loss Help ::: www.groupofindependentdoctors.com
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Causes and Effects
Stages of Baldness
Consultation Advice Form
Stages of hair loss

Below are illustrated the six
stages of male hair loss.
To find out more, click here.



Stage 1


Stage 2


Stage 3


Stage 4


Stage 5


Stage 6

For a free Initial Consultation, please complete the form below and click the submit button at the foot. Your names and email address must be filled in.
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Personal Details
Name
EmailAgeSex
Male Female
What colour is
your hair?
Do you wear a wig? At what age did your hair loss start?
Yes   No
Has your hair loss stopped? If it has stopped, for how long has your condition been stable? Does male hair loss run anywhere in your family?
Yes   No Yes   No
Is your hair straight or curly?
Straight      Slightly curly      Curly      Very curly
What stage of hair loss have you reached?
Stage 1  Stage 2  Stage 3  Stage 4  Stage 5  Stage 6
Do you have hair on the
top of your head?

If so, is it longer than 2 cm?
Yes   No Yes   No
At the back of your head, what distance is there from the
start of hair growth at the base of your neck to the point at
the top of your head where hair growth stops?
More than 10 cm      8-10 cm      6-8 cm      Less than 6 cm
Where do you wish to replace hair?
The front of your head and temples     
The crown of your head     
The whole area of hair loss
Please add any further information you think important
 
  
  
groupofindependentdoctors.com
Click here to go to Group of Independent Doctors Introduction page
The Group of Independent Doctors are all Plastic Surgeons based in Greece, a centre of excellence in the treatment of hair loss. You will be guaranteed personal, individual, discreet and confidential treatment by the doctor of your choice.
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website introduction page
To speak to a Consultation Manager in the UK
call 0845 6977230
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