Contact Form

Welcome to our Online Consult Contact Form! Fill out your information and one of our awesome Medilaser Team Members will contact you with consult dates to choose from. Please note all inquiries past 4pm will become priority the next business day AM. We look forward to seeing you!

First Name

Last Name

Phone

Birthday

Please note: We provide our Hair Transplant Consults virtually via phone, zoom, and/or Facetime every Thursday.

Our Medilaser Hair Specialist, Jessica, will be your virtual consultant. We look forward to speaking with you!

For Virtual Hair Transplant Consultations we need 2 pictures (Top of head facing forward and applicable graft donor areas)

Upload your hair pictures here

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Were you referred by a friend? If so, please list their name:

If you selected Google Search, may we ask what words you typed in the google search bar to find us?

What day is your best day for a Consult?

Please check the time slot that best fits your schedule.

Weekdays (M-F) - Morning 8am-12pm
Weekdays (M-F) - Afternoon 12pm-5pm
Flexible/As soon as possible
Saturdays - 9am-2pm (open one Saturday per month)
Hair Transplants (Virtual Consult on Thursdays)

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