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Free consultation form
For a virtual hair transplant consultation, please provide the following information and attach your photos.
Name:
 
City:  
 
Country:  
 
E-mail:  
   
Tel:
Sex: 
Male  Female
Age:  
Age at which your hair loss began:  
Relevant medical history (Diabetes, etc) :
Relevant surgical history (Keloid formation, Bleeding disorders, etc):
Family history of hair loss:
Previous hair transplant procedure :
If Yes, When and With whom?:
Previous hair loss medications:
To
To
From  To
Hair Colour:
Texture of hair:
Male baldness pattern:

Your expectations from procedure:
How did you find our clinic?
Please upload the required photos for better assessment (Max. file size: 200kb)
The top of your scalp :
Left profile :
Right profile
The back of the scalp :
Front hairline:
 
Contact Us
40, Daman Afshar Street, Valiasr Avenue, TEHRAN  19697 , IRAN
Phone:
(+98 21) 88881719
Fax:
(+98 21)  88206570
Email:
info@iranderm.net
Appointment
Our clinic is open to patients from 8:00 AM  to 8:00 PM, Saturday through Thursday.

To make an appointment, please call our appointment desk