Intake form

Hair transplant / Forehead reduction

Get your personal free hair plan

Full Name
Date of birth
In which country do you live?
Questions and Details
The more you fill in, the better we can help you!

Are you interested in a hair transplant or forehead reduction and could you share why?
Do you suffer from hair loss?
Do you have any allergies?
Any chronic illnesses? (blood pressure, diabets, etc.)
Any regular medication or supplements?
How long have you been thinking about doing this procedure?
Do you have any doubts, fears or other questions regarding the procedure?
Are you interested in going to the clinic in the Netherlands or Turkey?
Are you interested in a Solo trip or a Group trip?
The group trip consist of 2-5 people, I will join and guide everyone during the trip. The solo trip is without my presence, however everything will be arranged for you. Transportation airport - hotel - clinic, guidance by our member of the clinic. You can bring someone along if you want, the hotel room is available for 2 people.

Please send pictures of your hair (front, the sides and back side)