Please fill in this form. Our specialists will consider your problem and personally write you about the optimal solution for you.
Contact information

Please fill in at least the e-mail or phone number so we can contact you!

Name:
Country:
City:
E-mail:
Phone:
Personal information
Age:
Gender:
Hair color:
Hair type:
Hair structure:
Norwood Baldness Classification

Please indicate which picture looks like your hair the most, when wet.

Norwood 1 Norwood 2 Norwood 3
Norwood 3 vertex Norwood 4 Norwood 5
Norwood 6 Norwood 7
Ludwig Baldness Classification

Please indicate which picture looks like your hair the most, when wet.

Ludwig 1 Ludwig 2 Ludwig 3
Additional information
When did you begin to suffer from hair loss?
Did masses of baldness increase in the past few years?
Which part of head is missing the most hair?
Is your scalp visible?
Have you ever talked with a doctor or other specialist about your problem?
What kind of medications against baldness have you taken?
Have you ever had a hair transplantation operation?
Do you think hair transplantation could solve your hair loss problems?

If you have comments or aditional information please write it here: