Online Hair Restoration Consultation

Online Assessment

we offer free assessment for our patients

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First name*
Last name*
City*
Country*
Email*
Please confirm your email before submitting your request
Phone Number*
Adding your phone number can help us communicate faster
Gender*
Please select your Gender
- Male
- Female
- Other
Age*

Please provide pictures of your hair loss and donor area for an accurate assessment.

Please upload clear and full picture profiles of:

1.Front
2.Top
3.Sides
4.Back

Expose all loss and without any concealer.
Upload Consultation Photos
Drop files here or

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
Any additional details that you think we should know
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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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