Consultation - Insalaco Clinic

Email (required)*
Enter Email Confirm Email

Enter the email address where you would like to receive the evaluation
Do you use Finasteride?*
Indicate whether you are using Finasteride (Propecia or Proscar)
Da quanto tempo utilizzi Finasteride?
Do you use Minoxidil?*
Indicate if you are using Minoxidil
Da quanto tempo utilizzi Minoxidil?
Have you had a hair transplant before?*
Specify whether you have undergone a hair transplant in the past
What surgical technique was used in your previous surgery? *
Anno del precedente intervento
How many follicular units did you get?*
Please enter a number from 100 to 7500.
Enter the number of follicular units received in the previous surgery
Doctor who operated on you?
Indicate the name of the clinic where you have performed the surgery
Have you had more than one hair transplant in the past?*
Indicate whether you have undergone other transplants in the past
Indicates the number of grafted follicular units in your second transplant*
Please enter a number from 50 to 6000.
Surgical technique used for your second transplant*
Other HT - Description
Enter year of surgery, number of grafts and surgical technique of any other transplants performed

PAGINE 3 PHOTOGRAPHIC IMAGES: Photographs should preferably be taken with your face uncovered your privacy is guaranteed and the images remain in the clinic archives. It is very important to send photos according to the following rules: DON'T USE FLASH
FRONTAL VIEW*
Accepted file types: jpg, jpeg, gif, png, bmp.
Insert a front image
RIGHT PROFILE*
Accepted file types: jpg, jpeg, gif, png, bmp.
Insert a right profile image
LEFT PROFILE*
Accepted file types: jpg, jpeg, gif, png, bmp.
Insert a left profile picture
OVERHEAD VIEW*
Accepted file types: jpg, jpeg, gif, png, bmp.
Insert a complete top view
DONOR AREA (NECK AREA)*
Accepted file types: jpg, jpeg, gif, png, bmp.
Insert an image of the whole neck area
Authorization for the processing of personal data*
- I authorize
By ticking this box I authorize the processing of my personal data according to EU Regulation 2016/679

Dr. Chiara Insalaco