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HAIR RESTORATION
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1. Your Information
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PHONE
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DATE OF BIRTH
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2. Hair / Health Profile
WHEN DID YOU FIRST NOTICE YOU WERE LOSING HAIR?
HAVE YOU EVER USED ROGAINE
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HAVE YOU EVER BEEN PRESCRIBED AND USED PROPECIA?
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DO YOU TAKE ANY MEDICATIONS ?
DO YOU HAVE ANY EXISTING MEDICAL CONDITIONS OR ILLNESSES?
DO YOU SMOKE?
HAVE YOU HAD A HAIR SURGERY IN THE PAST?
TELL US ABOUT HAIR LOSS ON YOUR MOTHER'S SIDE OF YOUR FAMILY.
TELL US ABOUT ANY HAIR LOSS EXPERIENCED BY YOUR BROTHERS OR SISTERS.
3. Your Hair Procedure
WHAT DO YOU HOPE TO ACHIVE WITH HAIR RESTORATION, AND WHAT TECHNIQUE ARE YOU INTERESTED IN?
PRP Treatment
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SELECT THE AREAS OF YOUR SCALP WHERE YOU NEED HAIR RESTORATION
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Meet Dr. Sani
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Our Office
Hair Restoration
Platelet-Rich Plasma Hair Restoration
BOTOX Injections Hair Restoration
Microneedling Hair Growth
LaserBand 82 – HairMax
Nutrafol, Minoxidil & Propecia
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