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e.g. A friend or family referral, an existing patient referral, Google search, YouTube, Hair Discussion website/forum (if so which one?)
Have you taken hair growth medication or products (e.g. Rogaine / Finasteride / Minoxidil)?*
Upload Photos
    Upload instructions:
  • Take photos in evenly lit and bright rooms. Do not use flash. Maximum file size should be 5MB per image, images should have less than 3200px x 3200px dimensions.
  • 4 photos: Front, Back, Top, Side.

By clicking "I agree" you are allowing Cole Clinic to provide an estimate about your hair loss treatment procedure based on the photos and information you provided. Your submitted pictures will be private and secure and will not be used without your permission.
Please note a final consultation will be needed and all costs are estimates and may be subject to change.

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