Contact Info

Contact Info

Online Consultations / $500.00 rebate offer

OUR GIFT TO YOU!

You've already given yourself a gift by taking the initiative to research your options to increase your level of confidence. Now let us help your take the next step with a free consultation!

Register now, for a free, by appointment only consultation. You can contact us by phone or online, by completing the questionnaire below. Our personal consultation will provide you with the best solution to suite you and your lifestyle. Our professionally trained staff are able to answer all of your questions and concerns. We will provide a free microscopic hair and scalp analysis, a $250 value for you at no cost. As well we offer you a voucher for $500 towards the purchase of a Sure Hair system or transplant. Just simply print the voucher below and present it at the time of your free consultation.

Your Basic Contact Information:

First Name: Last Name: Email Address: City/Town: Province/State: Telephone (Optional): Years Experiencing Hair Loss:
How old are you?:
Are you Male or Female?

According to the chart below which stage of hair loss most closely resembles your own stage of hair loss? :

Please check the different hair loss solutions that you would like to find more about:

	Hair Transplants		Hair re-growth treatments
	Hair Replacement System		Laser Comb Therapy
	Hair loss concealer		Prescription Medications

Which of our office locations would you prefer to visit for your consultation/Treatment?

Optional comments or questions:

Please use the text area below to address any additional questions or concerns you may have regarding the restoration of your hair.