Let's Get The Hair You Deserve

Hair Transplant Assessment Form

Please complete this questionnaire to help us understand your goals. We use a 100% Selective Approach.

What are your primary hair goals for connecting with RQC Hair Transplant Clinic? *

Baldness

Hairfall

For how long have you had baldness/hairfall? *

how many months or years have you been noticing hair loss?

Why now is the right time for treatment? *

What motivated you to seek treatment at this time?

What Treatments Have You Tried to Solve Your Hair Concerns? & For how long? *

List medicines, oils, PRP, or homeopathies tried and their duration

Which Treatment you are Looking For ? *

If you are unsure, select what you think you need. Our doctors will guide you.

100% Selective Approach

We believe in helping people. If we are not confident in providing you an effective hair solution at our clinic, we will show you the right direction to resolve your hair problems.

Dr. Vivek Galani, our Chief Hair Transplant Surgeon, leads a team of 5 specialized doctors.

Our doctors have successfully treated 10,000+ patients with hair concerns similar to yours over the past 10 years. With this extensive experience, our doctors will provide you with a very effective, specific, and personalized solution that will work just like it has for our 10,000+ patients.

10 Years+

Experience

10,000+

Patients

5/5

Google Reviews

How do you wish to proceed? *

Choose how you'd like to receive your personalized consultation

1 to 1 call with Dr. Vivek Galani 799 INR for faster solutions For faster, personalized solutions

Only Information regarding cost of Hair Transplant treatment Receive details via email/whatsapp

Message for Dr. Vivek Galani *

Share any specific questions or concerns you'd like to discuss with the doctor

When to start treatment? *

Select your preferred timeline for beginning the treatmentas

Immediately

Within 1 Month

2 to 3 Months

After 3 Months

Schedule Your Call

Select a date and time to connect with our experts.

Select Date

Month Year

Sun

Mon

Tue

Wed

Thu

Fri

Sat

Available

Closed/Sunday

Available Slots

Select a date to view available times

Final Details

We need your contact information to confirm the appointment.

Full Name *

Age *

Phone (WhatsApp) *

Email Address *

Your email for appointment confirmations and treatment details

Location Details

COUNTRY *

STATE *

CITY *

How did you find us? *

Help us understand how you discovered our clinic

Instagram

Facebook

YouTube

Website

Google

Other

Occupation *

This helps us understand your lifestyle and schedule preferences

Hair Transplant Assessment Form

100% Selective Approach

Schedule Your Call

Select Date

Available Slots

Final Details

Location Details

Application Received!

What Happens Next?

Processing Your Assessment

Confirm Your Details