To consult with Dr. Raymond Konior, please provide the following information.
Then on the following pages you can attach your photo(s) .
Note - This form and any reply to it does not take the place of an actual in person consultation. The information you provide simply enables us to give you initial suggestions and advice.
Your Condition -> Personal Information -> Image Selection & Submission -> Additional Consults
Your Age:
Gender:
Male Female
Male Hair Loss Scale Men, click on the image closest to your hair loss condition.
Female Hair Loss Scale Women, click on the image closest to your condition.
Grade I
Grade II
Grade III
Have you used the following treatments?
Rogaine
Past
Present
Propecia
Your questions or concerns
Email Address: required
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