HOME MHR SOLUTIONS ABOUT HAIR LOSS BEFORE & AFTER Suffering from hair loss and considering hair transplant surgery, the permanent hair replacement solution? For many men and women, the benefits of a permanent solution to hair loss, hair restoration, is the right choice. Hair loss affects millions of men and women and no matter what people say we are all judged by our appearance. Take the first step to restoring your hair and confidence forever. At Medical Hair Restoration, we’ll explain the procedure and your options so that you are completely satisfied. Our goal is Quality Hair Transplant Patient Results. With our No Obligation, Free Consultation, you will learn first hand how hair transplant surgery can be your permanent hair replacement solution. Don’t live near any of our offices? We encourage those who are considering hair transplant surgery to visit the closest Medical Hair Restoration office for a hair replacement consultation and personal hair loss evaluation. If, by chance, you do not live near one of our hair transplant surgery centers, you may qualify for the Medical Hair Restoration Travel Advantage program. If you travel more than 100 miles one way for your in-person hair loss consultation, Medical Hair Restoration will help make your travel financially feasible by reimbursing you with a $50 Gas Card (please present travel receipts for verification). If you then decide to have hair transplant surgery with Medical Hair Restoration, we will reimburse you with 75 FREE grafts. Travel pay not contingent upon having surgery. Hair Transplant consultations, in-person or otherwise, are always complimentary and involve no obligation.

First Name:* Last Name:* Mr. Mrs. Ms. Dr. Lt. Rev. Address:* Apt/Suite: City:*State:* Zip:* Alaska Alabama Arkansas Arizona California Colorado Connecticut District Of Columbia Delaware Florida Georgia Hawaii Iowa Idaho Illinois Indiana Kansas Kentucky Louisiana Massachusetts Maryland Maine Michigan Minnesota Missouri Mississippi Montana North Carolina North Dakota Nebraska New Hampshire New Jersey New Mexico Nevada New York Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Virginia Vermont Washington Wisconsin West Virginia Wyoming Phone:* - - ext. Email:* How long have you been losing your hair? Less than a Year 1-5 Years 5+ Years Do you have hair on the back and sides of your own head? Yes No Is that hair healthy and not patchy? Yes No Is the hair on the back and sides of your head at least a quarter of an inch in length? Yes No