Online Consultation

We want to keep things simple so if you want an upfront estimated quote for a hair transplant in the UK simply fill in the form with a few pictures.

The form should take less than 2 minutes to complete.

Name*
First Last
Email*
Mobile Number*
Date of Birth*

Day
Month
Year
Postcode*
ZIP / Postal Code
Pictures are Essential
Please upload several photos for an upfront quote and personalised hair loss advice.
Front
Max. file size: 512 MB.
Back
Max. file size: 512 MB.
Side
Max. file size: 512 MB.
Additional Photos
Drop files here or

Max. file size: 512 MB.
Comments
Please include any relevant information. This should include your current hair loss treatments or any you have previously tried.
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 doctor and your patient coordinator at Hair Repair Clinic.
Your data is not shared with any other organisation or third party.

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