Online Diagnosis - Rahal Hair Transplant

Welcome Why Choose Rahal Hair Transplant 11 Reasons Meet the Man The Team

About Hair Loss Hair Growth Cycle Male Pattern Baldness

Female Hair Loss

Causes of Hair Loss Common Myths Treatments

Male - Norwood Scale

Female - Ludwig Scale

Surgery Medication

How much does a hair restoration cost? Fees and Financing Questions Deposit Cancellation/ Rescheduling Policy Planning Your Visit

FUT pricing

Travel Reimbursements Travel Arrangements Travel Documents

Confirmation Letter - Canada Customs Time off work Hotel Links Links to Ottawa Tourism Sites

US Travelers International Travelers

Evalution Form Photo Guidelines

Translation

Toronto Consult Office
Now Open

Watch Our Hair Transplant Videos on YouTube

FREE ONLINE CONSULTATION
If you would like a free online consultation, please complete the following form and don't forget to attach your photos. A free online consultation is only possible if the required photos are submitted.


Online Hair loss Assessment
	* required fields

First Name

Last Name

Email

Phone

Alternative Phone

Address

City

Province / State

Country

Postal Code

Preferred method of contact

Email Phone Land Mail

Sex

Male Female

Age

Hair Color

Texture of Hair

Thin Medium Thick

Waviness of Hair

Straight Wavy Pretty Curly

Family history of hair loss

Yes No

At what age did you begin to notice hair loss?

Less than 20 21-30 31-40 41-50 Over 50

Baldness Pattern

Are you mostly interested in:
Information
Pharmaceutical Treatment
Surgical Treatment

Scheduling a session:
Now In the following two months
In the following six months After consultation

What would you like to achieve with hair transplantation
(restore the front hairline, mid scalp, back, or your entire balding area)?

Have you ever consulted with a doctor about your hair loss condition? Yes No

If yes, with whom?

What treatment, if any, was recommended?

Have you ever had surgical hair restoration performed? Yes No

If yes, with whom?

Have you treated your hair loss with any of the following?
Rogaine: No   Past   Present
Saw Palmetto: No   Past   Present
Propecia: No   Past   Present
Other: No   Past   Present

Are you interested in receiving e-mail news about hair loss? Yes No

More Information

How did you find us?

By a friend referral	Forums
Used Before	Television
Web page Banner	Link from another site
Search Engine	Magazine / Newspaper Ad
Radio	Other


Photo Guidelines Make sure to submit digital photos or scanned print photos Use bright, natural room lighting - avoid flash! Shoot from a distance of 3 to 5 feet Images must not exceed 4MB Acceptable photo files are in the jpg/jpeg format

Recommended by The American Hair Loss Association	Recommended by The International Alliance of Hair Restoration Surgeons	Dr. Rahal is an elite member of the Coalition. Visit his recommendation on the Hair Loss Learning CenterX
Get answers to your questions on the IAHRS Hair Transplant Info Center

Dr. Rahal is recommended on the
Hair Transplant Network

Share your experience by authoring a Hair Loss Weblog.

Share ideas on our sponsored
Hair Loss Forum.

Hair Transplant Forum - Join The Community