Direct connections to the surgeons you are interested in!

Save time and receive the information you're looking for!

The Hair Transplant Magazine surgeon contact form, allows you to contact the selected surgeons of your choice in one simple process. By completing our form, the information you have submitted, will be sent to the surgeons you are most interested in.

* The information you supply us with, will be sent to only the surgeons you select and you will be contacted only via the method you indicate.

Personal Information
First Name
Last Name
State / Province
Country
How would you like to be contacted?
Phone Number
Email Address
Please select a surgeon that you wish to have contact you. Contact will be made according to your contact selection above (e-mail or phone). Please select one of the following surgeons:
Dr. Garbutt Dr. Alan Bauman Dr. Alan Feller Dr. Alvi Armani Dr. Andrew Denton Dr. Blaine Lehr Dr. Edmond Griffin Dr. Edward Bednar Dr. Glenn Charles Dr. H. Rahal Dr. Herbert Feinberg Dr. Ivan Cohen Dr. James DeYarman Dr. Jeffrey Epstein Dr. Jerry Cooley Dr. Jerry Wong Dr. John Cole Dr. John Bitner Dr. Kenneth Siporin Dr. Mark Baxa Dr. Mark DiStefano Dr. Nelson Ferreira Dr. Randall Sword Dr. Raymond Konior Dr. Robert Bernstein Dr. Robert McClellan Dr. Robert Jones Dr. Robert Leonard Dr. Sharon Keene Dr. Shelly Friedman Dr. Timothy Jochen Dr. Victor Hasson Dr. William Rassman
Are you willing to travel for surgery?   Yes No
Would you like to receive information about surgery financing options?   Yes No
Are you currently taking Propecia or Avodart?   Yes No
What anxieties, if any, do you have about surgery?
Is this your first surgery or are you seeking corrective surgery or surgery to add further density?
First surgery Increase density Corrective surgery
Do you have a targeted budget?
$5,000 - $7,000 $15,000 - $20,000 $7,000 - $10,000 $20,000 or more $10,000 - $15,000
Any general comments you wish to add:
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