Please complete our medical questionnaire for men

Thank you for enquiring with Ashley and Martin. To enable us to organise your remote consultation, please fill in the medical questionnaire form below, this questionnaire is important so that our consultant and doctor can make the most accurate diagnosis and treatment recommendations.

Once your medical questionnaire has been submitted one of our consultants from our Medical Hair Centre will call you to set an appointment for a time and day convenient to you for the online consultation.

Remote Consultation Photos Requirements