Kontaktformular für Haartransplantation: Ihre Anfrage stellen

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Contact form

Contact form for patients interested in a hair transplant. Fill in everything and we'll take care of the rest!

Friedrich-Freye-Str. 41 45481

Mülheim an der Ruhr, Germany

+49 176 209 691 88

info@panaceatourism.com

First name

Email

Date of birth

Last name

Area code

Phone number

Gender

When would you like to start your treatment?

At what point are you considering a transplant?

Head

Beard

Eyebrow

Somewhere else

Have you already had a hair transplant? *

No, I haven't had a hair transplant yet.

Yes, I have already had a hair transplant.

Yes, I have already had several hair transplants.

What level are you at on the Norwood scale? *

Level 1

Level 2

Level 3

Level 4

Level 5

Level 6

For a detailed analysis we need some photos of your head.

Uplaod image

I have read and acknowledged the privacy policy.

Privacy policy

I have read and understood the terms and conditions.Terms and conditions

Further information

Thank you very much, we will get back to you shortly!

PanaceaTourism

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+49 176 209 691 88

info@panaceatourism.com

45481 Friedrich-Freye-str. 43

Mülheim an der Ruhr. Germany

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