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Consultation Form

Free Online Consultation

Gender *
Email *
City *
How long have you been losing your hair?*
Family history of Baldness? *
Any major illness in past or present or taking any medications
Any relevant note or questions that you may think is important
Which No. of photo in the chart below matches with your hair loss? Only mentiont the number?

Submit us the views of photos of scalp as shown here taken in good light showing area of your hair loss and also showing the area where you have lost your hairs


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