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Quebec 418 622-7271

Saint-Hubert 450 656-2323

Quebec

Saint-Hubert

Hair Transplant
Hair Loss
- Hair Loss in Men
- Hair Loss in Women
Hair Treatments
Results
- Results of Hair Transplant Procedures for Men
- Results of Hair Transplant Procedures for Women
About Us
- About Us
- Careers
Resources
Contact
- Contact Quebec
- Contact St-Hubert
Fr

Hair Transplant
Hair Loss
- Hair Loss in Men
- Hair Loss in Women
Hair Treatments
Results
- Results of Hair Transplant Procedures for Men
- Results of Hair Transplant Procedures for Women
About Us
- About Us
- Careers
Resources
Contact
- Contact Quebec
- Contact St-Hubert
Fr

Hair Transplant
Hair Loss
- Hair Loss in Men
- Hair Loss in Women
Hair Treatments
Results
- Results of Hair Transplant Procedures for Men
- Results of Hair Transplant Procedures for Women
About Us
- About Us
- Careers
Resources
Contact
- Contact Quebec
- Contact St-Hubert
Fr

Make an appointment

Make an appointment

Hair Transplant
Hair Loss
- Hair Loss in Men
- Hair Loss in Women
Hair Treatments
Results
- Results of Hair Transplant Procedures for Men
- Results of Hair Transplant Procedures for Women
About Us
- About Us
- Careers
Resources
Contact
- Contact Quebec
- Contact St-Hubert
Fr

Hair Transplant
Hair Loss
- Hair Loss in Men
- Hair Loss in Women
Hair Treatments
Results
- Results of Hair Transplant Procedures for Men
- Results of Hair Transplant Procedures for Women
About Us
- About Us
- Careers
Resources
Contact
- Contact Quebec
- Contact St-Hubert
Fr

Hair Transplant
Hair Loss
- Hair Loss in Men
- Hair Loss in Women
Hair Treatments
Results
- Results of Hair Transplant Procedures for Men
- Results of Hair Transplant Procedures for Women
About Us
- About Us
- Careers
Resources
Contact
- Contact Quebec
- Contact St-Hubert
Fr

Virtual consultation form for women

This personal consultation form is your chance to get in touch with a PAI Medical Group hair consultant. Simply fill out this form and send it to us for a free, interactive consultation.

Consultation for men

Consultations Femmes ENG

Personal information

First name: *

Last name: *

Address: *

City: *

Province: *

Postal code: *

Phone: *

Email: *

Age

Specific info

For how long have you been losing your hair?

Do you think that your hair loss is genetic?

Yes

No

Hair color:

Scalp condition:

Hair Texture:

Hair Nature:

Hair length:

Itching:

Yes

No

On a scale of 1 to 10, how important is it for you to regain your hair?

1

2

3

4

5

6

7

8

9

10

According to the chart below, which image best represents the current state of your hair loss?

Additional information, questions, comments.

Would you prefer to be contacted by telephone or email?

Email

Phone

If you are human, leave this field blank.

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Quebec

220-325 du Marais St.
Québec (QC) G1M 3R3
418 622-7271

Saint-Hubert

3116 Moïse-Vincent Blvd.
Saint-Hubert (QC) J3Z 0C4
450 656-2323

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