Free hair consultation

👨‍⚕️ Hello, I'm Dr. A. Patel

Complete this professional consultation to receive personalized hair care recommendations based on your unique hair history and scalp condition

Step 1 · Personal Information

Full Name

Please enter your full name

Age

Please enter a valid age (12-100)

Gender

Please select your gender

Marital Status

Phone Number

Please enter a valid 10-digit phone number

Email (optional)

Step 2 · Hair Loss & Health History

Hair Loss Duration

Please select hair-loss duration

Daily Hair Fall

Please select daily hair fall

Scalp Condition

Please select scalp condition

Do you have dandruff?

Please select dandruff status

Type of Dandruff

How long have you had dandruff?

Severity of dandruff

Have you tried any dandruff treatments?

Other scalp issues with dandruff

Itching Redness Burning sensation Pimples/bumps Increased hair fall None

Hair Loss Pattern

Please select hair loss pattern

Sleep Quality

Please select sleep quality

Stress Level

Please select stress level

Family History of Hair Loss

Please select family history

Chronic Illness

Please select chronic illness

Please provide details about your chronic illness:

Chronic Skin Illness

Please provide details about your skin condition:

Vitamin Deficiency

Please select vitamin deficiency

Acute Illness (last 6 months)

Fever COVID Dengue Antibiotics Surgery None

Lifestyle Information

Water Intake (पानी पीने की मात्रा)

Physical Activity (व्यायाम)

Addictions / Substance Use (नशे की आदतें)

Scalp Exposure (धूप/धूल में रहना)

Previous Hair Loss Treatment?

Please select treatment history

Additional Hair History

Hair Care Routine

Chemical Treatments History

Diet & Nutrition

Step 3 · Scalp Analysis & Images

Identify Affected Scalp Zones

Click on the areas where you're experiencing hair loss or thinning

Scalp Zone Selection

Please select at least one affected zone

If tap not working – select zones manually

Norwood Scale Classification

Male Pattern Baldness Stages

Female Pattern Baldness Stages

Norwood Stage

Please select Norwood stage

Upload Front View

Click to upload front view

Upload Top View

Click to upload top view

Upload Side View

Click to upload side view

Image Upload Instructions

If you're having trouble uploading images:

Send your photos directly via WhatsApp to +91 93271 48908
Include your name in the message
Specify which view is which (front, top, side)

Step 4 · Personalized Recommendation

Suggested Treatment Kit

Kit Details

Your personalized kit recommendation will appear here based on your inputs

Ayurvedic herbs to nourish hair follicles

Modern science formula for effective results

Controls hair fall and strengthens roots

Improves scalp health and clears dandruff

Visible Improvement:

With consistent use, visible results typically appear within 2-3 months.

Doctor's Preliminary Assessment

Based on your inputs, I'll provide a preliminary assessment after you submit the consultation.

Additional Notes for Doctor

Your cart is empty

Your cart

Estimated total

Free hair consultation