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Let us help you with your hairline

Is hair loss causing you anxiety and stress?

Did you know that there are many medical based hair loss solutions available (SUITABLE FOR  BOTH MALES AND FEMALES) that can restore your hair – no matter how bad you think it is.

Simply complete the below evaluation form and we will be in touch at a suitable time to organise your consultation and then organise any prescribed products to be delivered directly to you.

 

 

MedHead Hair Loss Evaluation form (Males)

HAIR LOSS HISTORY

MEDICAL HISTORY

Please check all that apply to you

ALLERGIES

Maximum upload size: 10MB

DELIVERY ADDRESS

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