Alopecia Treatment Center Natural Remedies For Alopecia
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New Patient Registration Form
 
1
General information
* Field are mandatory !
 
Name *
Please enter your name
Age *
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Gender * Male Female

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Add. *
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  Type the complete address with city, state and zip code
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Tel. *
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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   Beauty Treatment and Hair loss
hair dye, hair colour, perming, straightening ect
General hair loss   Others      
4 Do you suffer any other medical conditions ? like thyroid, diabetes, hypertension, depression, stress, Irregular menstruation cycle, constipation, anemia etc describe here...
 
5 Describe if you have done any lab reports like Thyroid, female hormones, DHT, serum, ferritin, any type of biopsy report etc. (Skip this if you have not done any lab reports)
 
6 Quality of your hair
 
Normal Oily Brittle Thin
Rough and Dull Dry Blond Wavy
7 Attach the Pictures of only affected area. Each picture file size should not be greater than 3MB.
 
1.
2.
3.
If the hair loss is visible then pictures are helpful to make the diagnosis and preparing products.
If you are not able to submit the pictures now, please send it later to info@alopeciacure.com
If you don't want to send the pictures, please see the page "Types of alopecia" and mention the picture no. similar to your problem.
Picture No. Picture No. Picture No.
8 Payment Details (If you have already paid to any of our support center or online payment)
 
Give the payment details
OR   I shall pay later
9 Security Code ( * This is mandatory. This will help us to prevent automated registrations)
 
Enter the code shown
The code is case sensitive.
 


Notes
  • Registration is completely free. If your registration form is submitted successfully then you will get a confirmation message with patient id on 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.
 
 
 
Dr. Rohit Shah on Colors TV
 
clinic locator
 
Holly McGuffin, USA

Inspiring Journey
with
alopecia areata...

Trichologist
Holly McGuffin,
 

My 7 amazing days in India, to learn more about different types
of Alopecia

Dr. Sacha Piedallu
 
Before
Treatment
After
Treatment

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International Conference
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.
 
Articles
Unpredictable And Capricious Alopecia Areata (Dr. Rohits Article in Health and Nutrition )
 
Know more
Hair loss treatment
 
 
   
     Contact Information : Head Office  
Alopecia Treatment Center (Formerly known as Herbal Treatment Center)

 

  Alopecia Treatment Center
1/3839 Nani Desai Pole,
Nr. Maltiben's Hospital,
Soni Falia, Surat - 395003.
(Gujarat) India.
Phone : +91-261-2591146
Time : 1 pm to 6 pm (IST)
Email :   rohit@alopeciacure.com
Dr Rohit Shah   Ragini Shah
Dr Rohit Shah   Ragini Shah
     International Support Centers :      India Support Centers :
   USA More Details   Trichologist  Holly McGuffin Trichologist Holly McGuffin
   Canada More Details   Akshay Banker Akshay Banker
   UK More Details   Mrs. Patel Mrs. Patel
   Malaysia More Details   Shirley Lai Shirley Lai
   South Africa More Details   Dr. Sacha Piedallu Dr. Sacha Piedallu
   Ahmedabad More Details   Dr Sunil Shah Dr Sunil Shah
   Valsad More Details   Dr. Sahil Masalia Dr. Sahil Masalia
   Vadodara More Details   Dr. Bharat shah Dr. Bharat shah
   Vapi More Details   Dr. Sahil Masalia Dr. Sahil Masalia
   Gandhidham More Details   Dr. Ashok D. Thakkar Dr. Ashok D. Thakkar
   Mumbai More Details   Dr. Heena Quraishi Dr. Heena Quraishi
   Sangli (Maharashtra) More Details   Dr.Sonali Bapat  Dr.Sonali Bapat 
   Pune More Details   Dr Mahesh Bora Dr Mahesh Bora
   Nasik More Details   Dr Shailesh Londhe Dr Shailesh Londhe
   Indore More Details   Dr. Sanjay Kucheria Dr. Sanjay Kucheria
   Bangalore More Details   Merlin Subhashini Merlin Subhashini
   Bhubaneswar More Details   Dr Annada Prasad Dash Dr Annada Prasad Dash
   Rourkela More Details   Dr Annada Prasad Dash Dr Annada Prasad Dash
   Karnal (Haryana) More Details   Dr. Meenu Gandhi Dr. Meenu Gandhi

 

 

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Home Remedy Tips
Hairloss due to anemia
Hairloss (any type)
Hairloss due to color and dye
Premature graying of hair
Pattern Baldness
Dandruff
Lusterless, dull hair
Menopause and Hairloss
Pediculosis
Ultimate haircare tips
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