Name*
First Last
Please select your procedure or treatment*
- Hair Transplant
- Facial Hair Transplant (eg: beard, eyebrow, eyelash)
- Hair Loss Medication
- HRP (home hair recovery program)
- PRP (platelet rich plasma) Therapy
- Other (please enter details in the comments box)
Comments
Please enter details of the treatment you are interested in.
Gender*
- Male
- Female
Date of Birth*

DD
MM
YYYY
Email Address*
Mobile Number*
Address*
Please include your postcode so we can find the nearest clinic for you.

Postcode
Occupation
To assess and advise on your aftercare it would be great if you would describe the work you do, in other words how physically demanding your job is.
How did you hear about us?
We would love to know how you found Hair Repair Clinic, thanks in advance!
- Web Search (Google, Bing, Yahoo....)
- Social Media (Facebook, Twitter, Reddit....)
- Google Maps
- Email
- Friends and Family *
Comments
* Friends and Family
Did you know we pay a referral fee if your friend/family member books a procedure with Surgery Group? Contact us to find out more.
Assessing you hair loss
Which of the images below is closest to your hair loss pattern?*
Which of the images below is closest to your hair loss pattern?*
Patient Photos

Please include at least two photos as shown
Front View
Front View
Side View
Side View
Back View
Back View
Top of Head View
Additional Angles
Any additional angles you wish to include
Data Collection*
- I consent to my submitted data being collected and stored
We treat your information with respect.
The submitted data is used by your surgeon, your patient coordinator at Hair Repair Clinic and other health professionals to help ensure that you receive the best possible care.
Your data is not shared with any other organisation or third party.

Our Happy Customers

Matthew and the team have offered great advice and assistance both in the run up to surgery and in recovery.
Thanks so much! X

Emma Frankland

Matthew told me to use a shampoo to treat my scalp and get some antibiotics to treat the infection. I have been to see my GP about this a number of times and they were not only useless but unsympathetic.

Anonymous

AAA Service
Matt is a brilliant dedicated knowledgeable and sincere guy. I would highly recommend him and his services he provides to any of my family and friends Thanks Matt

Darren Leung

Excellent customer service, Mathew is a very experienced consultant who has alot of knowledge to share also !

Adil

Great customer service and pre/post op care from Matt. He’ll give good advice and all the info on anything you need to know. I’m extremely happy with the results and would 100% recommend to anyone!

Billy Scott

Great service provided once again from Dr Ismail's Hair Repair Clinic - top job! Excellent work and well done! Genuine happy customer 😊

Just had my FUE hair Transplant, wow just wow !!! Could not fault a single thing from the very start to the very end. Very professional in every respect , a massive thank you to Mathew who has been wonderful and so so reassuring and knowledgeable. The operation was faultless and I’m only on day 9 post op, but the results are the best I’ve seen, and I’ve done a lot of research. I would highly recommend

Scadden

I’ve been in contact with Mathew and Blue for over 3 years now who are both professional and extremely helpful. I’ve just had my 2nd hair transplant and would never dream not using these guys.

Liam Long

Great service and help from Matthew over the last 8 months who is there for any questions anytime as I work towards my FUE in May. I've been taken hair loss medication which is working wonders on the front of my hairline, and at a much more affordable rate!

Matt