Patient Information

Full Name *

Email Address *

Phone Number

Age
Select age range18-25 years26-35 years36-45 years46-55 years56-65 years65+ years
Preferred Clinic Location
Select preferred locationDubai, UAEOslo, NorwayIslamabad, Pakistan

Hair Loss Stage (Norwood Scale)

Select the image that best matches your current hair loss pattern:

NW1

NW2

NW3

NW3V

NW4

NW4A

NW5

NW5A

NW6

NW7

Areas to Restore

Select the areas you would like to restore:

Front Hairline / Temples

Mid-Scalp / Top

Crown

Important: We generally do not recommend prioritizing crown transplantation. Our main focus is the front and top for a visible, natural frame to the face.

Hair Characteristics

Hair Thickness
Medium (typical)FineCoarse/Thick
Donor Area Density
AverageHighLow
Hair Texture
StraightWavyCurly

Medical History

Previous Hair Transplant Surgery
NoYes
Still Losing Hair / Haven’t Lost Everything Yet
No, hair loss has stabilizedYes, still losing hair


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