VIRTUAL PRE-CONSULTATION FORM
The information you provide below allows us to gain a general understanding of your situation/hair concerns and provide you with initial recommendations. This form and any reply thereafter does not constitute a patient-physician relationship nor does it replace the in-person, comprehensive consultation with Dr. Max.
The in-person evaluation with Dr. Max includes a thorough medical history assessment, diagnostic hair loss evaluation, and advanced scalp microanalysis. A full consultation can be scheduled through our office for a fee of $150. This consultation fee would go towards any hair restoration procedure you opt for following your assessment
Please provide your details below to begin a Virtual Pre-Consultation. Any photos and personal information you share with Hair By Dr. Max, Restoration Center is treated confidentially, and will not be sold or shared with any third party.
PHOTO SUBMISSION INSTRUCTIONS
Preliminary photos of your hair loss can be submitted in order for us to to better assess and understand your case. Please use the following examples as guidelines for the angles of your head ideal for evaluation. All submitted photos and information will be kept confidential and will not be sold or shared to any third parties.
Our office will review your information and contact you with the further steps.
Example Photos
