Online Consultation


With our Online Consultation, free of charge and without any commitment, you can easily present your hair problem, whatever it may be, to our specialists.

Fill out the following form and you will be contacted in a timely manner with the result of the online consultation, where you will be indicated the most appropriate and effective treatment for your situation.

    Personal Data

    With what age did your hair loss began? *

    Have you ever undergone any surgical procedure for hair transplant? *

    Have you any family history of baldness? *

    Which family members have baldness? *

    Front photo (max 4Mb) *

    Rear photo (max 4Mb) *

    Top photo (max 4Mb)*

    Right side photo (max 4Mb) *

    Left side photo (max 4Mb) *

    What you would like to achieve with the hair transplant / Other information:

    * Required fields

    If you prefer you can also make a also free HAIR CONSULTATION at the MADEIRA HAIR CLINIC‘s facilities through the Online Form or through the clinic Contacts.