This is a quick 2-minute validated questionnaire offered to

The Hair Clinic, Face Doctors Remuera and Essential Mens Clinic

This consultation is designed for both men and women experiencing hair thinning or hair loss at any age

It is obligation free and absolutely confidential. 

Within 1 business day, one of our medical team will email you with:
• a summary of hair loss types
• our recommended treatment options
• indicative pricing and next steps (including in-clinic or telehealth options) 

Please note that by submitting this form, you will be signed up to the Hair Clinic newsletter. We respect your privacy and you can unsubscribe at any time.

Your personal details will remain confidential and not disclosed to any third parties. You have the right to view, change or delete this information on request. This questionnaire is not comprehensive, and does not replace a full history and physical examination and further information may be necessary on follow-up. Due diligence will be exercised for making a thorough assessment.