Qualification form

Do you want to check if you qualify for the procedure and how many grafts can be transplanted for you? Please fill out the form below; we respond within 24 hours at the latest.

Add at least 3 photos of your head to the form following the instructions below. Remember, the more photos, the better. The photos should be taken in good lighting and must be clear. The doctor needs to see the density of your hair.

Name

Surname

Phone

Your age

Gender

When do you want the procedure?

Referral code

Comments or questions

How did you come to our site

Add photos for qualification

When selecting files, select a few photos at once. If you have trouble uploading photos, fill out the form and send the photos to us at company email

I confirm that I have read the information obligation and consent to the processing of personal data by Jack Strong Hair, in order to respond to the inquiry (mandatory field for receiving a response to the inquiry)

Qualification form

Add photos for qualification

You will receive a reply to the email address provided in the form, no later than 24 hours.

Check the effects after the treatment

See what results our clients get after the treatment. All photos belong only to our customers from EU.