New Hair New You

(800) 642-9942

VIRTUAL

HAIR RESTORATION

Consultation

For those in the Los Angeles area, we can bring the expertise of Ziering Medical to you online. We invite you to get started by completing the form below.

During your virtual consultation, we will review your personal health history and the photo series that you submitted to determine if a Stress related hair loss procedure is the best option for you.

Ziering Medical offers three virtual consultation appointment options: Phone, SKYPE and Face Time.

Virtual Consult Website Form

First Name*
Last Name*
Full Name
First
Age*
Email*
Phone*
Address*
Street Address City State / Province / Region Country
Zip Code*
Family History Of Hair Loss
- Father
- Mother
- Maternal Grandparents
- Paternal Grandparents
Describe Any Underlying Medical Conditions You May Have:
What are you currently using to manage or treat your hair loss:
Describe Previous Hair Transplant Procedure(s):
Which procedures are you considering?
- FUSS (Follicular Unit Strip Surgery)
- FUE (Follicular Unit Excision and Extraction Surgery)
- Non-Surgical Therapies and Treatments
What Are Your Hair Restoration Goals:
- Coverage
- Density
To provide the best and most complete consultation please provide photos following the directions below.
Upload Your Hair Photo:
Frontal view; straight on
Upload Your Hair Photo:
Right view; straight on
Upload Your Hair Photo:
Left view; straight on
Upload Your Hair Photo:
Top view; straight on
Upload Your Hair Photo:
Back view; straight on
Source
Medium
Campaign
CAPTCHA
Comments
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