Online Diagnosis: DHI - Hair loss Clinics, Hair loss, Hair restoration : Online Diagnosis

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Online Diagnosis

If you wish before submitting your Online Diagnosis please refer to the Patient Cases

More than 100.000 satisfied DHI Customers!

It our vision is to make the DHI NO TOUCH Technique available in every city worldwide.
Our strict quality control protocol allows only highly trained dhi certified medical doctors to perform the procedure.
To date, we have trained fifty medical teams and they perform DHI procedures daily all around the globe.
The demand however for our amazing procedure far exceeds our capacity as we receive thousands of enquiries daily.

If you could please complete the form below.

If you are considering a DHI procedure within the next 12 month, we would advise you to pre-book your procedure dates 2 to 3 months in advance
Consultations and the DHI hair loss analysis test should be pre-booked 2 to3 weeks in advance.

Please read this first carefully:
By completing the Online Diagnosis form in as much detail as possible, we will be able to come back to you with a full and detailed complimentary analysis from the DHI Diagnostic Department Medical Team within the next few days.
In order for us to be as accurate as possible, please provide in detail the history of the evolution of your hair loss.
It will also be of great assistance if you can provide the Diagnostic Department Medical Team with clear, close up digital photos of your thinning and donor zones.

LONDON DHI SESSION FEE 2500 GBD

Contact Information

First Name	Last Name


City	State / Province	Country


Address	Zip Code	Email


Day Phone	Evening Phone	Mobile Phone


Sex	Age	Profession
Male Female

Hair Type

Hair Colour		Hair Texture		Hair Type
		Thin Medium Thick		Straight Wavy Curly

Is there a family history of hair loss?

Yes No

At what age did you begin to notice a change in your hairline?

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

Baldness pattern?

Class 1 Class 2 Class 3 Class 4 Class 5 Class 6

Are you interested to book a DHI Alopecia Hair test? (Read what a DHI Alopecia hair test is about, here)

Yes No

The following questions are optional and are intended make the follow-up to your online diagnosis more thorough and assist in making an informed diagnosis for your hair restoration procedure.

General Information

	I would like Session information about:
	Your minimally-invasive DHI hair restoration procedure Other non-invasive options for my hair restoration I would like information on scheduling a Session: Now Within two months Within six months After a Consultation

Background Information

	What would you like to achieve with D.H.I. (for example: restore the front hairline, mid-scalp, back, or perhaps your entire balding area)?


	Have you ever consulted with a doctor about a hair transplant?
	Yes No

	What hair transplant treatment, if any, was recommended?


	Have you undergone a surgical hair restoration?
	Yes No What type of restoration procedure was performed?

	Has your hair loss problem been treated with any of the following?
	Rogaine: No Past Present Saw Palmetto: No Past Present Propecia: No Past Present Other: No Past Present If other please indicate here:

Receiving Information

	Language Preference
	English Greek German

	How did you find us?

Types of Consultation

	DHI offers four different Consultation formats:
	Live consultation through Web Camera (installed and operational on your computer) By telephone: Please advise the best day and time for us to contact you By email (you will need to provide our consultant with photos of your potential hair implant area)

	Additional information you may wish to provide will be helpful.

Pictures

Please provide up to three photos (maximum 500kb per photo in .jpg format) to assist in your diagnosis.

	Photo 1:
	Photo 2:
	Photo 3:



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