Online Hair Transplantation Consult

To consult with Dr. Damkerng Pathomvanich, please provide the following information.
Then on the following pages you can attach your photo(s) .



Note - This form and any reply to it does not take the place of an actual in person consultation. The information you provide simply enables us to give you initial suggestions and advice.
Your Condition -> Personal Information -> Image Selection & Submission -> Additional Consults

First Name * Last Name *
Street Address
Zip Code Country *
Phone E-Mail *
Your Age * Gender *

Have you used the following treatments? *
Rogaine Past Present Never  
Propecia Past Present Never  
For how long have you been on any medication, if at all?
(NA) if never.


Insert Photo
(Width of photo not over 200px and only format *.gif, *.jpg, *.jpeg, *.png)*



Front



Top



Side



Back



Male Hair Loss Scale
Men, click on the image closest to your hair loss condition.
 

Female Hair Loss Scale
Women, click on the image closest to your condition.
 
 
  Grade I Grade II Grade III

Your questions or concerns :
Enter answer  : 
A answer:
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DHT Clinic
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