Online Hair Assessment | NOVA Capillaire

Your profile and the areas that concern you

You are

A man

A woman

Which areas would you like to treat?

Select your profile to activate the map

Selected zones

No zones selected.

Your age

30

Hair loss

How long have you been losing hair?

< 1 year

1-3 years

3-5 years

> 5 years

Have you already undergone a hair transplant?

Yes

No

When did you have your transplant?

Less than 1 year ago

Less than 5 years ago

More than 5 years ago

Current treatment (Minoxidil, Finasteride, PRP, etc.)?

Yes

No

Pregnant or breastfeeding currently?

Yes

No

Hair history

Do you have any disease or medical history to report?

Yes

No

You checked “Other,” specify the diagnosed disease

Ehlers-Danlos syndrome: specify the type, if you know it (optional)

Does your scalp currently have any known condition or peculiarity?

Yes

No

You checked “Other,” specify the peculiarity of your scalp

Are you a smoker?

Yes

No

Photos and additional information

Please attach clear photos of the concerned areas (face, top, back) :

Up to 3 files accepted: JPG, PNG or GIF. Maximum size: 5 MB per file.

Face

Add a photo

Back

Add a photo

Top

Add a photo

Additional remarks:

When do you wish to have the hair transplant?

Your contact information

Last name:

First name:

Email:

Phone:

Date of birth:

Protection of your personal data (GDPR)

Privacy: your information and photos are used only to study your request.
Indicative evaluation: remote analysis is informative and does not replace a medical consultation.
Accuracy: you confirm your information and photos are recent, accurate and unretouched.
Use of photos: they serve exclusively for the analysis of your file and are neither sold nor used for advertising purposes.
Storage: data, photos and documents submitted via this form are stored for 90 days, then automatically deleted from this form.
Your rights: you may request access, correction or deletion of your data at contact@novacapillaire.fr.