Our New Price is $2.95 per Graft

Many patients travel great distances to be treated by Dr. Friedman. Although in-person consultations are preferred because the doctor can better evaluate your hair loss, we do offer a virtual consultation for those who can’t visit our hair restoration facility in Scottsdale, Arizona.

After reviewing the information and photos you submit, the doctor will contact you by email. All information and photos are kept strictly confidential.

When completing this form, valid contact information is necessary to insure that you receive any promotional benefits offered by Scottsdale Institute.

How did you hear about us?

Male Hair Loss Scale

Classification of Male Pattern Baldness   Select an image closest to your condition.
IIIIIaIIIIIIvertexIIIaIVVIVaVIVIIVa

Female Hair Loss Scale

Classification of Female Hair Loss   Select an image closest to your condition.
Grade 1Grade 2Grade 3

Contact Information

(Valid Contact Information is Required)

  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: PastPresent
  2. Propecia: PastPresent
  3. Low Level Light Therapy: PastPresent

Personal / Health Information

  1. Age:
    		 Gender:
    MaleFemale
  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:

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