The Hair Clinic - Wig design booking form

Please fill in the form below as fully as possible. We will then contact you directly.

Please note that any information you supply will only be used for the purpose for which you have provided it and any relevant procedures following from this. This data will be maintained in strict accordance with the Data Protection Act and will not be passed on or sold to any other organisation without your prior approval unless this is a legal requirement.



Full name: (Required)

Postal address:
Post / zip code:
Country:

Home telephone:
Mobile telephone:
Work telephone:
Facsimile:

Email address:

Please indicate which method(s) you would prefer us to use to contact you:

Post
Home telephone
Mobile telephone
Work telephone
Facsimile
Email

If you are interested in booking an appointment please check the relevant box below:

I am interested in an appointment with the Consultant Trichologist
I am interested in an appointment regarding a Hair Transplant
I am interested in an appointment regarding a Wig or Hairpiece


How did you hear about us?:

Any other information:

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The Hair Clinic, at John Bell & Croyden, 50-54 Wigmore Street, London, W1U 2AU

Tel: 020 7224 4640 - Fax: 020 7224 3867 - Email: solutions@the-hair-clinic.co.uk

The Hair Clinic - Free Consultation with a Trichologist - Treatments for Hair Loss, Alopecia, Psoriasis and Scalp Problems

The Hair Clinic - Contact us

Book A Free Consultation With Our Wig Designer