ONLINE CONSULTATION FORM
* Field are mandatory !
General information :
Discription of your problem in your words
Which type of alopecia do you suffer ?
(Click here to see the photographs of different type of alopecia. )
Do you suffer any other medical conditions at present like...
Visual Examination:
Is there dandruff, fungus, lice, nits present on the scalp ?
Hair related lab reports: (skip this if you have not done any lab reports)
Quality of your hair
Photographs of the affected area with 2-3 different views
Attach photographs here:
1.
2.
3.
(the File size should not be more than 300 KB, File format should be .jpg, .gif, .tif, .png, .pcx or .bmp only)
If you are not able to send the picture using this form please send it with seperate email to info@alopeciacure.com
If you don't have any photograph, please see the page "what is alopecia" and mention picture no. of what is alopecia match with your problem.
Picture No.
Give the payment details (If you have already paid) (Order ID if paid by Credit Card / T.T. details / Cheque Number / Cheque Date / Bank name / Bank Branch etc.)
Dr Rohit has came back from USA / UK and he is now available at Alopecia treatment center, Surat.
Mumbai: (2nd and 4th Sunday) Crresshhha Polyclinc, Devi Ekveera A Building (Basement), Nr. HDFC, 79, Old Nagardas Road, Andheri (E), Mumbai - 400 069. Tel.: (022) 66989770 March - 14,28,April - 11,25,
Ahmedabad Dr Sunil shah [M.D.], 14/10 Vir-vijay Society, Near Sanghavi High School, Naranpura, Ahmedabad. Ph.:079-27410607 (first Sunday of the month) April - 4
Vidit shah [USA] A case of extensive alopecia areata successfully treated Read more...
Holly McGuffin [USA] 19 year young girl got her beautiful hair back Read more...
Fluer Hamill [NEW ZEALAND] is now happy to have such a beautiful hair.. Read more...
Hema [INDIA] 17 years young girl looks more confident now Read more...
Alopecia Treatment Center
1/3839 Nani Desai Pole, Nr. Maltiben's Hospital, Soni Falia, SURAT-395003. (Gujarat) INDIA.
E-mail: rohit@alopeciacure.com
Holly McGuffin
Livonia, MI 48152 USA
Mrs. Bhavna Patel
Gore Court, Kingbury, London.
Devi Ekveera A Building (Basement), Nr. HDFC, 79, Old Nagardas Road, Andheri (E), Mumbai - 400 069.
Dr Sunil shah [M.D.], 14/10 Vir-vijay Society, Near Sanghavi High School, Naranpura, Ahmedabad.
Dept. of Dermatology (Mahabir Dal Hospital)
Dr. Meenu Gandhi, Dept. of Dermatology, Mahabir Dal Hospital, Kunjpura Road, Karnal, Haryana.
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