Book A Consultation

Use the form below to request an initial online hair transplant assessment from ASMED. Your information and clear photographs of your scalp, including the donor area, will be used for a preliminary evaluation by Dr. Koray Erdoğan and an initial cost estimate.

The online assessment is preliminary. Your suitability for the procedure and your treatment plan will be finalized during an in-person consultation at ASMED.

Consultation Form

Please, follow points 1 and 2 below in order to schedule a personal and professional evalutation of your condition:

1) Correctly fill-in the space related to your personal and contact information, and also the questions in each section.

2) Upload your pictures to this form by clicking on the “take photo” tab below or by attaching your own photo file. Photos must be clear, of good quality, and show the real condition of your scalp including the donor area (the posterior part of your head).

Personal Information

Name

Phone

E-mail

Date of Birth

Country

City

Profession

Questionnaire

1) WHICH PART / PARTS OF YOUR HAIR DO YOU WISH TO IMPROVE THROUGH AN FUE HAIR TRANSPLANT? WHAT TYPE OF RESULT DO YOU EXPECT TO GAIN?

2) WHICH TYPE OF FUE PROCEDURE IS OF INTEREST TO YOU?
• NORMAL FUE (the hair in the donor and recipient areas are shaved prior to surgery)
• LONG HAIR FUE (the hair in both the donor and recipient areas are left unshaven)

3) ARE YOU CURRENTLY USING ANY MEDICATION TO PREVENT HAIR LOSS? IF "NO", ARE YOU WILLING TO BEGIN MEDICATION RECOMMENDED BY THE DOCTOR? (Examples of medication commonly used to prevent hair loss caused by androgenetic alopecia: Finasteride, Dutasteride, Minoxidil, others – please, specify)

4) HAVE YOU EVER UNDERGONE A HAIR TRANSPLANT SURGERY? (If "YES", please indicate the date you had the surgery, the type of hair transplant surgery (FUE / FUT), the name of the doctor and the clinic, the number of grafts and considerations regarding the obtained result)

5) HAVE YOU EVER UNDERGONE ANY TYPE OF SURGERY IN THE PAST? (E.g. Appendectomy, Arthroscopy, Coronary Artery Bypass etc. If “YES”, please indicate which surgery)

6) DO YOU HAVE ANY HEALTH ISSUES AT THE MOMENT OR HAVE YOU EVER HAD ANY HEALTH ISSUES IN THE PAST? (E.g. Arrhythmia, high blood pressure, diabetes, anemia, epilepsy, hemophilia, kidney problems, liver problems, depression or other psychological problems, hepatitis B -C, HIV etc. -If you had one or several of indicated or any other health issue; please specify-)

7) DO YOU USE ANY TYPE OF MEDICATION FOR SERIOUS AND/OR CHRONIC HEALTH ISSUES OR HAVE YOU EVER NEEDED TO USE ANY TYPE OF MEDICATION FOR SERIOUS AND/OR CHRONIC HEALTH ISSUES? (E.g. Hypertension, diabetes, depression, stomach problem treatment, blood thinners -aspirin, clopidogrel, heparin-, protein or other supplements, hormonal treatments etc., if "YES", please specify)

8) ARE YOU ALLERGIC TO LOCAL ANESTHESIA (Anesthetics: Lidocaine; Articaine; Prilocaine etc. which are commonly used in dental procedures) OR ARE YOU ALLERGIC TO ANY MEDICATION OR ANYTHING IN GENERAL? (If "YES", please indicate your type of allergy)

9) HAVE YOU EXPERIENCED ANY SIDE EFFECTS FROM ANY MEDICATION THAT YOU HAVE TAKEN IN THE PAST? (If "YES", please indicate which medication)

10) DO YOU HAVE ANY SKIN PATHOLOGIES? (E.g. dermatitis, desquamation, folliculitis, tendency towards hypertrophic or keloid scarring)

11) WHAT IS THE LEVEL OF BALDNESS AMONGST THE MALE MEMBERS OF YOUR FAMILY AND IS IT INHERITED FROM MATERNAL OR PATERNAL RELATIVES?

12) HOW WERE YOU INTRODUCED TO THE ASMED CLINIC AND DR. KORAY ERDOGAN? (E.g. recommendation of a friend/doctor/patient who has already undergone surgery, website, forum, other. Please respond precisely.)