HAIR LOSS EVALUATION FORM

Begin your journey toward a natural, thicker, more youthful head of hair. Complete the form below to help our hair restoration experts determine if laser therapy is right for you.

Your Privacy is Important to Us. Your answers will be confidentially reviewed by Capillus® to determine if low level laser therapy is suitable for you. For immediate assistance, call 1-786-888-6249 or email us. Your privacy and security are our top priorities. For more information, review our Privacy Policy.

We need to know a little bit about you & how you want to be reached...

Address

Now we need a little history on your hair health

  • Recent Searches
  • capillus 11
  • Capillus 272 battery charger 11
  • dark skin 1
  • capillus 272 11