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Online Consultation

Please fill in the questions below in order for us to gain an idea of the treatment that would best suit your needs.

Stage 1 of 3

First Name*
Last Name*
Age*
Email*
Phone number
Address 1
Address 2
Town*
Postal code
How did you hear about Farjo?*
Have you seen one of our DVDs?

Stage 2 of 3

Age when hair loss started
Is the loss stable now?
If loss stable how long for?
Family history of hair loss
maximum of 50 words
Previous hair medicine
maximum of 50 words
Previous hair surgery
maximum of 50 words

Stage 3 of 3

Skin Colour
Hair Colour
Hair Quality
Hair Loss Scale
Upload Top Left Photo
Upload Top Right Photo
Upload Back Photo
Upload Top Photo
Any other information
maximum of 400 words