My Hair Clinic – Assessment Form

MY HAIR CLINIC

Advanced FUE Hair Transplantation – Assessment Form

Patient Information











Areas to Restore

Select the areas you wish to restore (at least one required):

Note: You can select one front area option + crown if needed









Hair Characteristics (Optional)

These factors help refine your assessment:







Medical History






Note: Repair cases may require modified planning and additional consultation.
Still losing hair / Haven’t lost everything yet


Enable this if you’re experiencing ongoing hair loss or in early stages






Contact My Hair Clinic
UAE WhatsApp: +971 58 247 0065 | International WhatsApp: +47 939 23 223
Email: info@myhairclinic.ae | info@myhairclinic.com
Dubai Clinic: 4013, Block C, Al Razi Medical Complex, Building 64, DHCC, Dubai, UAE
Free online consultation available. No walk-ins.