Contact Dr . Epstein for a
Hair Loss Consultation
Consultation


Please send me a brochure
Request a WebCam Consultation
How you would like 
to setup a consultation? 
First Name 
Last Name 
Address 
City 
State   
Zip Code 
Country 
Daytime Phone 
Preferred Email Address 
Referred By 
I want to schedule a 
consultationwith 
Privacy is necessary: 
Yes   No
     
Age 
Age at onset of hair loss 
How fast does hair loss 
currently seem to be progressing? 

Medications taken for hair loss (please give dates and effectiveness):
Rogaine (minoxidil) 2% 
Rogaine (minoxidil) 5% 
Minoxidil plus Retin-A 
Propecia (finasteride) 1mg 
Proscar (finasteride) 5mg 
Other 

Check Which Members of Family Have/Had Significant Hair Loss:
Father Mother
Paternal Uncle Maternal Uncle
Paternal Grandfather Maternal Grandfather
Brother(s) Other 

Indicate Your Current Hair Condition:
Hairline Normal Thinning Very Thin Bald
Frontal Recession Normal Thinning Very Thin Bald
Frontal Area Normal Thinning Very Thin Bald
Mid Scalp Normal Thinning Very Thin Bald
Crown / Back Normal Thinning Very Thin Bald

Using the following diagrams, Indicate Your Current Hair Loss Pattern
and the Hair Loss Pattern You Believe You May Progress To in the Future :

 Men, please complete this first Hair Loss Pattern Chart.
Women, please complete the one below.

  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To

Women, please complete the following Hair Loss Pattern Chart. The Men's chart is above.
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To
  Current Pattern May Progress To

Indicate All the Characteristics of Your Hair:
 
Hair Color Black Brown Gray Blonde
  Red Salt & Pepper
Hair Curl Straight Slightly Wavy Wavy Curly
Hair Thickness Fine Medium Medium Coarse Coarse
 
Past Hair Surgery History (dates, physician/clinic, graft number):
 
Please Describe Your Goals for Hair Restoration:
 
 
Which of the Following Would Be Most Helpful to You (Indicate All that Apply):
 
In-Depth Consult Talking to Patients
Meeting Patients Viewing a Procedure
Frontal:
Top:
Side:
Back:

Virtual Consultation

For patients who are unable to attend an in-office consultation, we provide a virtual consultation at no cost. Simply fill out the virtual consultation form and submit photographs showing your current state of hair loss.

Guidelines for Photographs

Please follow the guidelines listed below when submitting your photographs. This will allow your virtual consultation to be as close as possible to an in-person consultation.

When taking your photographs:

  • Do not use a flash. Instead, take the photographs in a room with bright, natural lighting.
  • Have the photographs taken from a distance of three to five feet.
  • Keep the target in focus and centered in the frame.

When submitting your photographs:

  • Use digital photos or print photos that have been scanned.
  • Use jpg or jpeg file types.
  • Do not exceed 4MB (4,000kb) per photograph. Larger photographs must be resized.
  • If your photographs exceed the size limit, you may resize them by downloading PhotoResize800.exe (Windows only). After download, the PhotoResizer icon will appear on your desktop. You may then drag and drop specific photos or folders containing photos onto the icon. The PhotoResizer will then automatically resize the photos, creating smaller copies of them.

For your virtual consultation, we will require photographs showing the following angles:

  1. The top of the head. A photograph showing the top of your head will provide us with an overall view of your current hair loss, including the degree of current hair loss as well as potential hair loss that may occur in the future.
  2. Side profiles. Photographs showing the left and right sides, or profiles, also demonstrate the extent of hair loss.
  3. The back of the head. Two photographs should be taken of the back of the head, or scalp. One should simply be a photograph of the back of the head. The other should be taken of the back of the scalp while you are pulling up a horizontal strip of hair in the donor area using your hand or a comb. This second photograph will help us to assess the density of donor hair.
  4. Hairline. A photograph of the front hairline will allow use to see how your hairline frames your face. If you have an idea how you would like your hairline to look, you may demonstrate this by drawing your hairline on your scalp.

     


If you live in or are visiting south Florida, a consultation needs to be scheduled. You will meet personally with Dr. Epstein in an informal yet confidential setting. An accurate assessment of your present and future hair loss pattern will be provided, and a course of treatment decided upon. Helpful staff are available to discuss financial issues. To schedule a consultation please call us at 1-800-370-2883, email us, or use the convenient online form above.

If you are not in the south Florida area and it is difficult for you to travel to the office for a consultation, you have other options: the Hair Loss History Questionnaire Package. When completed and mailed back to the Foundation for Hair Restoration you will be contacted by the office, and have the opportunity to speak with Dr. Epstein directly. Or, even simpler, call us at 1-800-370-2883 or email us, or use the form above, and a phone consultation with a quote will be arranged. You may then schedule your procedure simultaneously with your visit.  As an added service, computer imaging can also be performed on photos you send electronically to show you what to expect from a procedure.

Miami
305-666-1774 or toll-free 1-800-370-2883
Sunset Professional Building
6280 Southwest 72nd Street (Sunset Drive), Suite 504
Miami, FL 33143

Boca Raton
561-750-0525 or toll-free 1-800-370-2883
200 Glades Road, Suite 2
Boca Raton, FL 33432

New York
(212) 759-3484 or toll-free 1-800-370-2883
60 East 56th Street
3rd floor
East Side Care Center
New York, NY 10022

Tampa
We are in the process of moving meanwhile we are seeing one on one consultations with Dr. Epstein at the Renaissance Hotel (across from Neiman Marcus)

Renaissance Hotel
4200 Jim Walter Blvd
Tampa, FL 33607
Toll free 1-800-370-2883

West Los Angeles
11500 W. Olympic Boulevard, Suite 315
West Los Angeles, CA  90064
800-370-2883

Westborough
2 Connector Road, Suite 2C
Westborough, MA 01581
800-370-2883

German Office
Peter-Dassis-Ring 33
57482 Wenden
Germany

Like what you have seen?  To learn even more, click here to visit the Foundation for Hair Restoration

 

Womens Center For Hair Loss - 6280 Southwest 72nd Street, Suite 504 Miami, FL 33143 - 800-370-2883