Contact Us to Request Info



Once you have decided to move forward, we need you to send us photographs so that we may fully assess your hair transplant requirements. Additionally, our entire team of professionals are here to support and coach you through this experience.

speak to a patient advisor

You will be contacted by one of our hair transplant Patient Advisors within 24 hours of submitting your photos. Consequently, they will review your photos along with what will be required to achieve your goals.

Schedule your procedure with a surgeon

Your Patient Advisor will set up the appointment with your hair transplant surgeon. Subsequently, your surgeon will go over all the details of the procedure. You are in good hands.

Call: 1 (800) 510-3386 to get started


Please fill out this form to learn more about treating your hair loss and your options with hair transplants or alternative treatments. Additionally, you can submit your hair loss photos to us, which will give us a better understanding of your hair loss and an approximate idea of your hair replacement needs.

Once received, one of our doctors will carefully review your photos and provide you with a thorough evaluation and recommendation.

Your Information

Your information and photos become a part of your medical file at HRC, and we prioritize your privacy. Rest assured, we will not sell, trade, lease, or give that information to anyone – ever.

Should you have more questions, comments, or helpful information to provide after completing this form, please do not hesitate to contact us again. An asterisk (*) indicates a required field.

    First Name:

    Last Name:




    Zip Postal Code:


    Best time to call:



    Personal / Health Information





    Please list any existing medical conditions or allergies:

    *Any family history of baldness or thinning hair?

    *Did baldness or thinning hair come about rather suddenly?(required)

    *What is your time frame to proceed?

    Will you require financial assistance?(required)

    Please include any additional information, concerns or questions that will help us to better fulfil your request


    Photo Submission


    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.

    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 extent 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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