Hair Transplant, Hair Restoration & Repair
110 East 55th Street, New York, NY
Telephone: 212.826.2400 		 Schedule a Hair Transplant Evaluation
Schedule a
Hair Transplant
Evaluation
Expert advice on Hair Transplants and Repairs in New York and New Jersey

Photo Consults for Persons Outside the NY Tri-State Area

It is always best to have a personal one-on-one consultation with Dr. Bernstein, so that he may evaluate you and offer specific recommendations. Click here to schedule an in-person consultation.

If you live outside the tri-state area (New York, New Jersey, Connecticut) and are unable to come in for an evaluation for a surgical transplant, you can use our photo consultation form below. After reviewing your information and photos, Dr. Bernstein will contact you by e-mail.

If you would you like to have a photo consultation with Dr. Bernstein, please complete the form, and upload your photos below:
* Required fields  
* First Name:
* Last Name:
* Email Address:
   Phone:
   Address:
* City:
* State/Province:
   Postal Code:
* Country:
   Age at which your
   hair loss began:
* Date of Birth
* Current Age
* Gender Male
Female
What are your goals for your hair restoration?
Previous hair transplant procedures or other types of hair restoration surgery. Please indicate dates and type of procedure (if known):
Relevant surgical history (i.e. one that might affect a hair transplant procedure such as keloid formation, bleeding disorder):
Relevant medical history (i.e. one that that might affect hair transplant surgery such as diabetes):
Began Propecia:
Began Rogaine:
Other:
Please send only the most representative photos. A front view (either full-face or eyebrows-up), ¾ view, and a top view are the most helpful.
NOTE: PHOTOS MUST BE JPG FORMAT
Front view (either full-face or eyebrows-up)
¾ or side view
Top view
Rear view
If you prefer to mail your photos, please send them to:

Bernstein Medical, P.C.
110 East 55th St., 11th Fl
New York, NY 10022
* How did you hear about us?
Other Referral:
Comments:
   

110 East 55th Street, 11th Fl., New York, NY 10022    212-826-2400
Toll Free: 1-866-576-2400  contact@bernsteinmedical.com