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Dr. Sharma

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Get in touch with the Canadian Hair Transplant Centre

Contact us for a free hair transplant consultation and get started on your transformation today.

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Book a Free Hair Transplant Consultation

Complete the form below to book a free hair transplant evaluation with Dr. Sharma.

Name(Required)

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Phone Number(Required)

Email(Required)

Date of Birth(Required)

DD slash MM slash YYYY

Gender(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Alberta Health Card Number Number

Occupation

Medical History

To help us understand your medical history, please select the answers that best apply to you from the options below.

What is your current hair loss concern

Starting to thin

Scar coverage

Receding hairline

Beard

Bald spot forming in crown

Eyebrow(s)

Corrective surgery

Corrective surgery

What are your personal hair restoration objectives?

Hairline restoration

Stop hair loss / decrease shedding

Touch‐up, refinement of previous surgery

Overall coverage

Crown coverage

Other

Where are you in your hair restoration process?

I've had a hair transplant

I'm interested in starting non‐surgical treatment (Finasteride, Minoxidil/Rogaine, 82F, PRP)

I'm interested in scheduling a surgical procedure within the next 90 days.

I'm interested in scheduling a surgical procedure within the next year

Are you on any hair loss medication?(Required)

Are you currently or have you previously used Propecia/Proscar/Finasteride?

Yes

No

How long have you been experiencing hair loss?(Required)

Do you have a family history of hair loss?(Required)

Do you have any allergies?

Yes

No

Do you drink alcohol regularly?

Yes

No

Do you smoke regularly?

Yes

No

Are you being treated for any medical conditions at the present time or with in the past year?

Yes

No

Medical History Continued

To help us understand your medical history, please select the answers that best apply to you from the options below.

Any additional information regarding your health you think is important for us to know?

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Medical accuracy reviewed and approved by Dr. Anil Sharma, MD – Licensed Medical Doctor.

This page adheres to the standards set by the International Society of Hair Restoration Surgery (ISHRS) and Health Canada. No surgical claims are made regarding outcomes or permanence without prior in-person consultation and clinical evaluation. All procedures described are performed by a licensed physician and are intended for informational purposes only. Individual results may vary.

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About
Knowledge Centre

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About
Knowledge Centre

SURGICAL
NON-SURGICAL
- Non-Surgical Hair Loss Solutions
- Finasteride Microneedling
Results

SURGICAL
NON-SURGICAL
- Non-Surgical Hair Loss Solutions
- Finasteride Microneedling
Results

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Edmonton, AB T6G 1C3
780-476-7970

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