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First name*
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Phone Number*
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Gender*
Please select your Gender
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Age*

Please provide pictures of your hair loss and donor area for an accurate assessment.
Upload Consultation Photos
Please upload clear and full picture profiles of: 1.Front 2.Top 3.Sides 4.Back Expose all loss and without any concealer.
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Family Hair Loss?*
Please specify family members and extent of loss

Are you taking any hair loss medications?*
If your medication is not listed here, please list it in the "Additional Information" field.
What are your hair transplant goals and what would you like to achieve?*
For example: restore the front hairline, mid scalp, back, or your entire balding area with FUE or Body Hair
Additional Information
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About BHR Clinic

BHR performs hair restoration surgery using advanced technology and Dr. Bisanga’s unique artistry and design.

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