Alopecia Treatment Center
ayurvedic   Dr. Rohit's Natural Remedies For Hair Loss
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Home » Start the treatment now » New Registration Form  
 
1
General information
* Field are mandatory !
 
Name *
Age *
  
Gender * Male Female
Add. *
City * Tel. *
Country * Alternative Tel.  
E-mail * Alternative E-mail  

Email Id is very important for future communication, please be careful while typing email id and make sure that you typed it correctly.

2 Description of your problem in your words
 
3
Which type of alopecia do you suffer ? Skip this if you don't know the type of hair loss or
click here to see different types of alopecia.
 
Male pattern baldness Female pattern baldness Diffuse unpattern alopecia
Alopecia areata Alopecia totalis / universalis Scaring alopecia
Tellogen Effluvium Chronic Tellogen Effluvium Chemotherapy and hair loss
Traction alopecia Trichotillomania General hair loss      Others
4 Do you suffer any other medical conditions? (like thyroid, diabetes, hypertension, depression, stress, Irregular menstruation cycle, anaemia etc.) Describe if you have any lab reports or biopsy.
 

5 Attach the Pictures of only affected area. (File size should not more than 3 MB )
 
6 Do you want to schedule Skype live consultation with Dr. Rohit Shah ? *Skip this if you are not interested.
 
Dr rohit shah
  skype   Live Consultation Fees:
For Indian patients: INR 2000 for 15 minutes.
For abroad patients: USD 200 for 30 minutes

 
Yes. I am interested.

* Conferencing time will be given later. * Preferred languages English or Hindi.
7 Payment Details
 
8 Security Code ( * This is mandatory. This will help us to prevent automated registrations)
 
 
 
Notes
  • Registration is completely free. If your registration form is submitted successfully then you will get a confirmation message with patient idon your registered email address.If you do not receive your patient id then please submit your details again.
  • Patient id is necessary for any future communication,sending picture files, placing an order or follow up treatment.
  • After receiving your details , the team of our expert doctors will give their opinion within 3-7 days.
  • If you are not able to send online form click here to download the consultation form in MS Word format .
  • By submitting this form you are agreed to our terms and conditions.
 
 
1
General information
* Field are mandatory !
 
Name *
Age *
  
Gender * Male Female
Add. *
City * Tel. *
Country * Alternative Tel.  
E-mail * Alternative E-mail  

Email Id is very important for future communication, please be careful while typing email id and make sure that you typed it correctly.

2 Mention your Patient ID or name of the patient and select the branch where you registered first.
   
Patient Id or Name of the Patient:
*  
 
 
Doctor & Branch Name:
(Select the support center or name of the doctor, where you registered first time.)
3 What changes did you notice after staring herbal treatment ? describe in your words.
 
4 Attach the latest picture of affected area after starting the treatment.
 
5 Payment Details
 
6 Security Code ( * This is mandatory. This will help us to prevent automated registrations)
 
 
 
Notes
  • Treatment package is specially designed according to country weather.
  • Abroad Indian patients are requested not to apply for Indian products but apply for
    the group of the country where they belong to.
  • Product will be send by Courier / Speed Post.
  • Online Tracking is only available if provided by Courier / Post / AirMail.
  • Approximate time to receive the products. For abroad patients 17-20 days ( depending upon the country).
  • Approximate time to receive the products. For Indian patients 7-10 days.
  • Product will be couriered after realization of Payment.
 
 
Quick Support
New patient registration
Want to send an E-mail?
What exactly in the treatment?
Cost and payment
Want to start the treatment?
Follow up patient registration
Know your nearest branch
 
Common Types of Hair Loss
Common Types of Hair Loss
 
Read Global Testimonials
 
Video Testimonials
 
International Support Centers
USA Canada
South Africa UK
Singapore Malaysia
Hong Kong Malta
UAE
 
India Support Centers
 
For Mumbai Patients

Dr Rohit's schedule for next three months The Founder of Alopecia Treatment Center, Dr. Rohit Shah personally visits Mumbai, every 2nd and 4th Sunday of the month. For prior appointment Call : 022-66989770, 26836187

January 28
February 25
 
Conferences
Dr. Rohit Shah, in International Conference and Exhibition on Cosmetology & Cosmetics, which was held in November 23-24, 2012 Hyderabad, India. The conference was arranged by OMICS Group.Dr. Rohit explained how Ayurveda Herbal Treatment is safe and potential way to cope up with Alopecia Areata.
 
Media / Article
Read more..
 
 

Contact Information : Head Office
Alopecia Treatment Center (Formerly known as Herbal Treatment Center)
Dr. Rohit Shah, 1/3839 Nani Desai Pole, Opp. Rupal Hospital,
Soni Falia, Surat - 395 003. Gujarat. India.
Time: 1.00 to 6.00 p.m.     Tel: +91 261 2591146-47
Cell: 0091 94283 94100     E-mail: info@alopeciacure.com
International Support Centers :
India Support Centers :
Alopecia Treatment Center (Formerly known as Herbal Treatment Center)

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Types of alopecia
Home Remedy Tips
Our Branches Alopecia areata Ultimate hair care tips
Registration for new patient Scarring alopecia How to deal with Dandruff ?
Registration for follow up patient Male pattern baldness Foods you must eat for hair growth
Cost & Payment Female pattern baldness Common factors lead to hair fall
Therapy results Diffuse pattern alopecia Female hair loss
Global Testimonials Telogen effluvium General hair loss
Frequently asked questions Chronic telogen effluvium PCOS related hair loss
What exactly in the treatment Trichotillomania Pediculosis
Media & Articles Traction alopecia Premature graying of hair
Myths Chemotherapy & hair loss Meopause & Hair Loss
    5 best ways to stimulate hair follicles
    Top ayurvedic remedies to control hair fall
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