LaseRenew SmartXide, Laser Skin Resurfacing, DOT Therapy

Free Online Consultation

Take the first step to feeling good and looking great, complete the online consultation form below. We will respond as soon as possible with advice and recommendations. Alternatively if you would like to meet us in person, click here to arrange a Free Consultation at our medical centre. (*required field)

Your Details

Full Name*
Tel Number*
Email Address*
Home Address
Age*
Weight*
Height*
Sex*	Male Female

Your Hair History & Current Situation

At what age did you begin losing your hair?	About years
Have you been losing it at the same rate since hair loss started?	Yes No
Has it levelled off with time?	Yes No

Please click the button next to the picture that best resembles your current hair loss:

Previous Treatments

Have you undertaken any medical treatment (Minoxidil and/or Propecia and/or vitamins) in the past? Have you already undergone a hair transplant ? Please provide any useful information in the field below.

Your Hair Quality

How thick is your hair ?	Very thin Thin Average Thick
What was your original hair colour?	Red Blonde Auburn Brown Black
Is the hair in the nape of your neck thick ?	Yes No

Pictures

Attaching images of the areas you wish to have treated will greatly assist us, and enable us to give you better advice and recommendations. Please use only JPEG format upto 4.0MB max size.

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Questions & Comments

Please provide any other information or specific questions you would like us to answer.

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