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Online Consultation Form

Online Consultation Form

Woman
Man
None
Light
Light-Medium
Medium
Extensive
Completely
Preview
Choose your hair loss in the frontal area.
None
Light
Light-Medium
Medium
Medium-Extensive
Extensive
Choose your hair loss in the crown area.
None
Light
Light-Medium
Medium
Medium-Extensive
Extensive
Blond
Brown
Ginger
Black
Duration
Less than 1 year
More than 10 years
No
Yes
As soon as possible
Within 3 months
In 1 year
I haven't planned it yet.
No
Yes
For Gennext Pharma to be able to perform your hair analysis, please share your photos which represent your current condition.
From the front
From sides
From behind
Top down