Formulaire de consultation

Greffe De Cheveux Formulaire de consultation

Utilisez notre outil gratuit pour une première évaluation de votre propre problème de perte de cheveux par notre personnel médical.


Grâce à notre outil d’évaluation de perte de cheveux, vous pouvez nous fournir des informations importantes concernant votre problème de perte de cheveux. S’il vous plaît remplissez le questionnaire et soumettez-le et nous vous contacterons avec un diagnostic initial fait par un de nos médecins spécialistes. Cette évaluation est gratuite et ne vous oblige en aucun cas à réserver une session de greffe de cheveux à Swiss Luxury Clinic.
In which of the categories below do you belong?
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For illustration purposes, we need some photos of your hair
(max 5 MB / photo)
A photo showing your face from the front
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A photo showing your profile
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A photo showing the back of your head
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How old are you?
You need to be older than 18
You need to be older than 18
What is your origin?
  • - select a option -
  • European
  • Arabic
  • Asiatic
  • African
  • North American
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What is your hair color?
  • - select a option -
  • Blonde
  • Brown
  • Red
  • Black
  • Grey
  • White
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What is your hair type?
  • - select a option -
  • Straight
  • Wavy
  • Curly
  • Very Curly
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Do you have a family history of hair loss?
  • - select a option -
  • No
  • Yes
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Field is required!
Have you already consulted another doctor?
  • - select a option -
  • No
  • Yes
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If yes, which of these methods were proposed to you?
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Have you ever had any other hair transplantation?
  • - select a option -
  • No
  • Yes
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If yes, which method was used?
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Field is required!
Field is required!
  • - select your country -
  • Åland Islands
  • Afghanistan
  • Albania
  • Algeria
  • American Samoa (US)
  • Andorra
  • Angola
  • Antigua and Barbuda
  • Argentina
  • Armenia
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bermuda (UK)
  • Bhutan
  • Bolivia
  • Bosnia and Herzegovina
  • Botswana
  • Brazil
  • Brunei
  • Bulgaria
  • Burkina Faso
  • Burma (Myanmar)
  • Burundi
  • Cambodia
  • Cameroon
  • Canada
  • Cape Verde
  • Central African Republic
  • Chad
  • Chile
  • China
  • Colombia
  • Comoros
  • Congo, Democratic Republic of the
  • Congo, Republic of the
  • Cook Islands (NZ)
  • Costa Rica
  • Croatia
  • Cuba
  • Cyprus
  • Czech Republic
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • East Timor (Timor-Leste)
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Ethiopia
  • Falkland Islands (UK)
  • Faroe Islands (Denmark)
  • Fiji
  • Finland
  • France
  • French Guiana
  • French Polynesia (France)
  • Gabon
  • Gambia
  • Georgia
  • Germany
  • Ghana
  • Gibraltar (UK)
  • Greece
  • Greenland (Denmark)
  • Grenada
  • Guam (US)
  • Guatemala
  • Guernsey (UK)
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Honduras
  • Hong Kong (China)
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran
  • Iraq
  • Ireland
  • Isle of Man (UK)
  • Israel
  • Italy
  • Ivory Coast
  • Jamaica
  • Japan
  • Jersey (UK)
  • Jordan
  • Kazakhstan
  • Kenya
  • Kiribati
  • Korea, North
  • Korea, South
  • Kosovo
  • Kuwait
  • Kyrgyzstan
  • Laos
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libya
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • Macau (China)
  • Macedonia
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Mauritania
  • Mauritius
  • Mayotte (France)
  • Mexico
  • Micronesia, Federated States of
  • Moldova
  • Monaco
  • Mongolia
  • Montenegro
  • Morocco
  • Mozambique
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • New Caledonia (France)
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue (NZ)
  • Norfolk Island (Australia)
  • Northern Mariana Islands (US)
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Palestinian territories
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Pitcairn Islands (UK)
  • Poland
  • Portugal
  • Qatar
  • Réunion (France)
  • Romania
  • Russian Federation
  • Rwanda
  • São Tomé and Príncipe
  • Saint Helena, Ascension and Tristan da Cunha (UK)
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Pierre and Miquelon (France)
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Saudi Arabia
  • Senegal
  • Serbia
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Sudan
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Svalbard and Jan Mayen (Norway)
  • Swaziland
  • Sweden
  • Switzerland
  • Syria
  • Taiwan
  • Tajikistan
  • Tanzania
  • Thailand
  • Togo
  • Tokelau (NZ)
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom
  • United States
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Vatican City
  • Venezuela
  • Vietnam
  • Wallis and Futuna (France)
  • Western Sahara
  • Yemen
  • Zambia
  • Zimbabwe
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How did you hear about us?
  • - select a option -
  • Other client
  • Medical abstracts
  • TV
  • Radio
  • Newspaper
  • Other
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You must agree to the Terms & Conditions and our Privacy Policy to continue.
You must agree to the Terms & Conditions and our Privacy Policy to continue.
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Swiss Luxury Clinic Hair Transplants

Prise de rendez-vous

Veuillez remplir les informations demandées ci-dessous afin que nous puissions vous contacter pour obtenir plus d’informations concernant vos questions sur la perte, transplantation et la restauration des cheveux.

+41 (0) 434883707 [email protected]