Although patients come from all over to have Dr. Friedman perform their hair restoration procedure, an in-person consultation isn't always convenient. Submit your photo for a virtual consultation.

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Male Hair Loss Scale

Select an image closest to your condition.  I II IIa III IIIvertex IIIa IV V IVa VI VII Va

Female Hair Loss Scale

Select an image closest to your condition.  Grade 1 Grade 2 Grade 3

Contact Information

1. Your Name:
   
2. Address:
   

3. City:

   State/Province:

   Zip/Postal Code:

4. Phone:

   Best time to call:

5. Email:
   

Have you used the following treatments?

1. Rogaine:  Past Present
2. Propecia:  Past Present
3. Low Level Light Therapy:  Past Present

Personal / Health Information

1. Age:	Gender:  Male Female

2. Please list any existing medical conditions or allergies:
   

Additional Information

Please include any additional information, concerns or questions that will help us to better fulfill your request.

Questions / Comments

Guidelines for Photographs

Please follow the guidelines listed below when submitting your photographs. This will allow your virtual consultation to be as close as possible to an in-person consultation.

When taking your photographs:

• Do not use a flash. Instead, take the photographs in a room with bright, natural lighting.
• Have the photographs taken from a distance of 3 - 5 feet.
• Keep the target in focus and centered in the frame.

When submitting your photographs:

• Use digital photos or print photos that have been scanned.
• Use jpg or jpeg file types.
• Do not exceed 4MB (4,000kb) per photograph. Larger photographs must be resized.

Provide photos showing the following angles:

	Front hairline We need to be able to understand how your existing or new hairline frames your face. This is imperative for the review process. If possible, take some time to draw your hairline on your scalp to show us where you would like to have it placed. This helps us to understand your desires and expectations from the procedure. Upload Photo:
	The top of your scalp This gives us an overall view of your hair loss situation. The top view is important as it helps us determine the amount of existing hair loss and possible future hair loss. Upload Photo:
	Oblique profile The profile is very important in assessing the needs of our patients. The profile helps us understand the extent of hair loss. Upload Photo:
	The back of the scalp If possible, include a photograph with your donor hair pulled up either with your hand or with a comb. This helps us determine your donor density. Upload Photo: