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Be our guest -- Take a "HAIR RESTORATION VACATION..."
(as seen on CNN & in USA TODAY)

Relax and be pampered after your state-of-the-art hair restoration procedure in beautiful South Florida. World-renowned luxury accommodations and amenities await you here in Palm Beach, Florida. Whether you enjoy golf, tennis, relaxing spas or even world-class shopping, take advantage of our year-round tropical climate during your visit to IHRS. For the convenience of our out-of-town patients, we have assembled a variety of travel and accommodations packages that can fit any style, time-frame and budget.

*Click Here For More Information*

Please read this first carefully:

By completing the Online Diagnosis form in as much detail as possible, we will be able to come back to you with a full and detailed complimentary analysis from the IHRS Medical Team within the next few days.

In order for us to be as accurate as possible, please provide in detail the history of the evolution of your hair loss.

It will also be of great assistance if you can provide the Diagnostic Department Medical Team with clear, close up digital photos of your thinning and donor zones.

Contact Information

First Name	Last Name


City	State / Province	Country


Address	Zip Code	Email


Day Phone	Evening Phone	Mobile Phone


Sex	Age	Profession
Male Female

Hair Type

Hair Colour		Hair Texture		Hair Type
		Thin Medium Thick		Straight Wavy Curly

Is there a family history of hair loss?

Yes No

At what age did you begin to notice a change in your hairline?

Less than 20 21-30 31-40 41-50 Over 50

Baldness pattern?

Class 1 Class 2 Class 3

Class 4 Class 5 Class 6

General Information

	I would like Session information about:
	Your minimally-invasive IHRS hair restoration procedure Other non-invasive options for my hair restoration I would like information on scheduling a Session: Now Within two months Within six months After a Consultation

Background Information

	What would you like to achieve with IHRS. (for example: restore the front hairline, mid-scalp, back, or perhaps your entire balding area)?


	Have you ever consulted with a doctor about a hair transplant?
	Yes No

	What hair transplant treatment, if any, was recommended?


	Have you undergone a surgical hair restoration?
	Yes No What type of restoration procedure was performed?

	Has your hair loss problem been treated with any of the following?
	Rogaine: No Past Present Saw Palmetto: No Past Present Propecia: No Past Present Other: No Past Present If other please indicate here:

Receiving Information

	Language Preference
	English Spanish French

	How did you find us?

Types of Consultation

	IHRS offers four different Consultation formats:
	Live consultation through Web Camera (installed and operational on your computer) By telephone: Please advise the best day and time for us to contact you By email (you will need to provide our consultant with photos of your potential hair implant area)

	Additional information you may wish to provide will be helpful.