Konsultationsformular

Haartransplantation Konsultationsformular

Benutzen Sie unser kostenloses tool, um sich von unserem medizinischen Team eine erste Beurteilung Ihres Haarausfalls erstellen zu lassen.


Mit unserem tool zur Beurteilung Ihres Haarausfalls können Sie uns wichtige Informationen über Ihr Haarausfallproblem mitteilen. Füllen Sie bitte den Fragenbogen aus und senden Sie ihn uns zu, und wir werden Sie mit einer ersten, von einem unserer Spezialisten erstellten Diagnose kontaktieren. Diese erste Diagnose ist kostenlos und verpflichtet Sie in keinster Weise, eine Haartransplantationssitzung in der Swiss Luxury Clinic zu buchen.
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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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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  • - 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.
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Swiss Luxury Clinic Hair Transplants

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Bitte füllen Sie die unten angeforderten Informationen aus, damit wir uns mit Ihnen in Verbindung setzen können, um weitere Informationen zu Ihren Fragen zu Haarausfall, Haartransplantation und Haarwiederherstellung zu erhalten.

+41 (0) 434883707 [email protected]