Wizard Form | Ble Mac Clinic

Please select your gender

Female

Male

Which area bothers you?

Receding hairline

Back of head

Light hair

Mild baldness

Hair loss area/s

receding hairline

back of head

Both

Mild baldness

Your hair texture?

Straight

Wavy

Curly

Your hair texture?

Straight

Wavy

Curly

Do you or did you do therapy’s for your hair like PRP treatments or mezo?

Yes I do

I did in past

I didn’t

Do you use medicine? (like blood pressure,…)

Yes

No

Thank you for answering the questions!

We will contact you as soon as possible!

Name and surname

E-mail

Phone number

We only need 3 photos of your hair for your hair diagnosis.

Just click and get started

from the front

from above

Behind