Patient Information

Full Name *

Email Address *

Phone

Age

Preferred Clinic Location
DubaiOsloIslamabad

Hair Loss Stage (Norwood Scale)



NW2




NW3




NW4




NW5




NW6




NW7


Areas to Restore *

Front Hairline/Temples

Mid-scalp/Top

Crown

Beard/Facial Hair

⚠️ Crown Consideration

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 Caliber
MediumFineCoarse
Donor Density
AverageLowHigh
Hair Curl
StraightWavyCurly


Prior hair transplant surgery

Still losing hair / haven’t lost everything yet


I consent to processing my information for consultation purposes *

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Your FUE Plan

Complete the form and click “Get My Assessment” to see if you’re a good candidate for FUE Hair Transplantation.

✅ Assessment Sent Successfully!

Your detailed hair restoration assessment has been sent to your email address. Please check your inbox (and spam folder) for your personalized graft estimate and treatment plan.

Next step: Schedule your FREE consultation with Dr. Hussain at +971 58 247 0065

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Medical Disclaimer: This recommendation is based on the information you provided. It is not a final quote. The plan may change after Dr. Hussain reviews your photos or following a live consultation.