Hair Transplant Womens | Miami, FL

Jeffrey Epstein, MD FACS

Hair Loss in Women
How We Diagnose
How We Treat
About us
Photo Gallery
Contact Us

305-666-1774

BOOK A CONSULTATION

Hair Loss in Women
How We Diagnose
How We Treat
About us
Photo Gallery
Contact Us

History Consultation

- Request a WebCam Consultation
How you would like to setup a consultation*
First Name:*
Last Name:*
Street:
Street Address City State / Province / Region ZIP / Postal Code Country
Daytime Phone:
Preferred Email Address:*
Referred by
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
- Brother(s)
- Paternal Uncle
- Maternal Uncle
- Paternal Grandfather
- Maternal Grandfather
- 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
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:
- In-Depth Consult
- Talking to Patients
- Meeting Patients
- Viewing a Procedure
Frontal:
Max. file size: 50 MB.
Top:
Max. file size: 50 MB.
Side:
Max. file size: 50 MB.
Back:
Max. file size: 50 MB.
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Thanks for visiting the Womens Center For Hair Loss and taking the first step towards learning about our commitment to providing the very finest in hair restoration since 1994.

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Miami Office

MIAMI
Sunset Professional Building
6280 Sunset Drive, Suite 504
Miami , FL 33143

Call us to assist you.
305-666-1774 - Miami

European Office

SERBIA
Colic Hospital
5 Surdulicka Street
11000 Belgrade, Serbia

Call us to assist you.
+38169-3488-348 - European Office

HOURS OF OPERATIONS

Monday: 9AM–5PM
Tuesday: 9AM–5PM
Wednesday: 9AM–6PM
Thursday: 9AM–5PM
Friday: 9AM–5PM
Saturday: CLOSED
Sunday: CLOSED

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