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Which ‘HAIR THINNING’ Treatment Is Right For Your Specific Hair Loss Type?
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About
Dr Rapaport
Our Office
Hair Restoration
Platelet-Rich Plasma Hair Restoration
Dutasteride Mesotherapy
Male Hair Restoration
Female Hair Restoration
EnerJet Needle Free PRP
Kerafactor Skin Care for Hair
HairMetrix Diganostic Imaging
Take a Hair Questionnaire
COVID-19 and Hair Loss
Hair Loss FAQ
Gallery
Payment Plans
Reviews
Contact Us
About
Dr Rapaport
Our Office
Hair Restoration
Platelet-Rich Plasma Hair Restoration
Dutasteride Mesotherapy
Male Hair Restoration
Female Hair Restoration
EnerJet Needle Free PRP
Kerafactor Skin Care for Hair
HairMetrix Diganostic Imaging
Take a Hair Questionnaire
COVID-19 and Hair Loss
Hair Loss FAQ
Gallery
Payment Plans
Reviews
Contact Us
(551) 212-8805
(551) 212-8805
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Take a Hair Questionnaire
1. Basic Info
2. State of Your Hair Health
3. History of Hair Treatments
4. Upload Your Hair Photos
Hair Restoration
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1. Your Information
Your Name
(Required)
First
Last
Phone
Email
Date of Birth
MM slash DD slash YYYY
Your Address
Street Address
Address Line 2
City
ZIP Code
2. Hair / Health Profile
WHEN DID YOU FIRST NOTICE YOU WERE LOSING HAIR?
HAVE YOU EVER USED ROGAINE
HAVE YOU EVER BEEN PRESCRIBED AND USED PROPECIA?
DO YOU TAKE ANY MEDICATIONS ?
DO YOU HAVE ANY EXISTING MEDICAL CONDITIONS OR ILLNESSES?
DO YOU HAVE ANY EXISTING MEDICAL CONDITIONS OR ILLNESSES?
DO YOU SMOKE?
HAVE YOU HAD A HAIR SURGERY IN THE PAST?
TELL US ABOUT HAIR LOSS ON YOUR MOTHER'S SIDE OF YOUR FAMILY.
TELL US ABOUT ANY HAIR LOSS EXPERIENCED BY YOUR BROTHERS OR SISTERS.
TELL US ABOUT ANY HAIR LOSS EXPERIENCED BY YOUR BROTHERS OR SISTERS.
3. Your Hair Procedure
SELECT THE AREAS OF YOUR SCALP WHERE YOU NEED HAIR RESTORATION
Front
Top
Small Crown
Expanded Crown
4. Upload your photos
Front Photo
Drop files here or
Select files
Max. file size: 300 MB.
Top Photo
Drop files here or
Select files
Max. file size: 300 MB.
Back Photo
Drop files here or
Select files
Max. file size: 300 MB.
Left Photo
Drop files here or
Select files
Max. file size: 300 MB.
Right Photo
Drop files here or
Select files
Max. file size: 300 MB.
About
Dr Rapaport
Our Office
Hair Restoration
Platelet-Rich Plasma Hair Restoration
Dutasteride Mesotherapy
Male Hair Restoration
Female Hair Restoration
EnerJet Needle Free PRP
Kerafactor Skin Care for Hair
HairMetrix Diganostic Imaging
Take a Hair Questionnaire
COVID-19 and Hair Loss
Hair Loss FAQ
Gallery
Payment Plans
Reviews
Contact Us
About
Dr Rapaport
Our Office
Hair Restoration
Platelet-Rich Plasma Hair Restoration
Dutasteride Mesotherapy
Male Hair Restoration
Female Hair Restoration
EnerJet Needle Free PRP
Kerafactor Skin Care for Hair
HairMetrix Diganostic Imaging
Take a Hair Questionnaire
COVID-19 and Hair Loss
Hair Loss FAQ
Gallery
Payment Plans
Reviews
Contact Us