Fantastic, you've made the right choice. Your life is about to change for the better.

To place an order please fill out our New Patient Intake Form below.

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Your email address and the password you enter below will be used to login to our order system to track your order.

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Patient Signature

By typing your name in the box below, you are consenting to become a patient of the doctor conducting your consultation for the treatment of hair loss.

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