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• Yes
• No

• FUE
• FUT
• Both

• Never Used
• Used in the past
• Currently using as prescribed

• Never Used
• Used in the past
• Currently using

• FUT
• FUE

MM slash DD slash YYYY

Accepted file types: jpg, jpeg, png, gif.

Photo Instructions

Ensure the room is evenly lit and bright. This is best accomplished in the daytime using natural light.

1. Do not use a flash. It obscures the scalp. If you think you need a flash, you need a brighter room.

2. Take several photos for each angle we request. Pick the photo from each set that has the best focus and clarity and best represents what you feel is the reality of your condition.

3. Place the camera slightly higher than your scalp, not at the same height.

4. Make sure that the photos show the loss that you are concerned about. Pull your hair back if your normal style hides the recession or loss.

5. When you have selected each of the six photos we require, upload each photo below.

6 . When the photos have completed being uploaded, click “submit” at the bottom of the page and wait for confirmation that the form has been sent. Do not go to another page before the submission is complete or else we will not receive your request.

Please make images 6mb or less

Allow us 24 to 48 business hours to reply with your personal hair restoration assessment prepared for you by Dr. Arocha.

Accepted file types: jpg, jpeg, png, gif.

Upload extra photo that helps to identify specific loss issues. For instance, if your hairstyle hides your hairline recession, include a photo with your hair pulled back.