Hair Transplant Interest Form

*
1.

Your age

Under 25
25-35
36-45
45+
*
2.
Main area of hair loss
Front hairline
Crown (top)
Both
General thinning
*
3.

Have you had a hair transplant before?

Yes
No
*
4.

Are you currently using any hair loss treatment?

Minoxidil
Finasteride
None
Other:
*
5.

Do you plan to travel to Shanghai for surgery in the next 3–6 months?

Yes
Maybe
Just exploring options
*
6.

If you're in the U.S., which time zone are you in?

Eastern (ET)
Central (CT)
Mountain (MT)
Pacific (PT)
Not in the U.S.
*
7.

Preferred contact method:

Email
WhatsApp
WeChat
*
8.
E-mail or Phone number
*
9.
Your name
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