Online Consultation | Hair Repair Clinic

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.

Online Consultation

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

DD
MM
YYYY
Postcode*
ZIP / Postal Code
Please upload several photos for an upfront quote and personalised hair loss advice.
Front*
Back*
Side*
Additional Photos
Drop files here or
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.