Hair Replacement, Hair Transplants, Repair
110 East 55th Street, New York, NY
Telephone: 212.826.2400                        Bookmark This Page
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Expert advice on Hair Transplants and Repairs in New York and New Jersey


Photo Consult

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:
    * First Name:
    * Last Name:
    * Email:
       Phone:
       Address:
       
    *  City:
    *  State/Province:
        Zip:
    * Country:
       Age at which your hair loss began:
    *  Date of Birth  (DD/MM/YY)         Current Age
    *  Gender Male
Female
 
       Relevant medical history, i.e. one that that might affect
       hair transplant surgery (such as diabetes):

       
       Relevant surgical history i.e. one that might affect a hair transplant
       procedure (such as keloid formation, bleeding disorder ):

       
       Previous hair transplant procedures or other types of hair restoration        surgery. Please indicate dates and type of procedure (if known):

       
       Hair loss medications:
       Propecia Began:
       Rogaine Began:
       Other Began:
       
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:  

       Comments:
       (Please include any additional information that you think would be         helpful to the doctor.)

       
       * Required fields
 
 

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