• Patient Form

    Please fill the following form. Dr. Cortez will analyze your information and photos to determine if you are candidate for hair transplant.



  • Please upload a picture of your Front Head like the example

  • Please upload a picture of your head like the example.

  • Please upload a picture of your head like the example

  • Please upload a picture of your head like the example

  • Please upload a picture of your head like the example