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Online Consultation Request
Dear Visitor, the Online Consultation Form allows you to send your hair condition details for advice. Please fill in the form and send it to us. Once received, our patient coordinators in conjuction with our doctors will reply with an in depth study and diagnosis to your hair loss problem. You can also send us your digital photos by a separate e-mail. This will give us the opportunity to give a better recommendation for your hair condition. Thanks for your interest in our clinic.
Personal Information
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Hair Condition
At what age did you begin to experience hair loss? Invalid Input
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Baldness Pattern for Men:

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Treatment Requirement
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General Information
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