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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. Our clinical strength mobile device for home use, Capillus272 Pro laser therapy cap, is available through select physicians.  If you are a candidate for laser thearpy for your hair loss, you can purchase the Capillus272 Pro at an authorized Capillus physician’s office or have it shipped to your home.

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.