First Name *

Last Name *

Gender (assigned at birth) *

- Select -

Male
Female
No elements found. Consider changing the search query.
List is empty.

Please enter your birthday *

Did you have surgery? *

- Select -

Yes, I had FUE
Yes, I had FUT
No, I did not have surgery
No elements found. Consider changing the search query.
List is empty.

If you had surgery, what month and year?

Are you using any of the following?

Father

Mother

Siblings

Aunts, Uncles or Grandparents

None of the above

Do you have any questions or concerns you would like to address with Dr. Stoller?

Example - Top of Head

Top of Head Image Upload *

Max. file size: 50 MB.

Example - Front of Head

Front of Head Image Upload *

Max. file size: 50 MB.

Example - Right Side of Head

Right Side of Head Image Upload *

Max. file size: 50 MB.

Example - Crown of Head

Crown of Head Image Upload *

Max. file size: 50 MB.

Example - Back of Head

Back of Head Image Upload *

Max. file size: 50 MB.

Captcha