Hair Restoration Consultation

Fill out the form below and include photos showing your hair loss. We will review your information and send you a quote for surgery.

By submitting the form below, you will receive $100 off our FormRx Hair Regrowth System and a $500 coupon which can be applied to your hair restoration surgery.

Hair Restoration

Form for patients who are interested in hair restoration
What questions can we answer about Hair Restoration?
Drop files here or
Max. file size: 50 MB, Max. files: 3.
    Please submit a photo of the front, top, and back of your hair loss.

    Plastic Surgeon SLC

    Request An Appointment


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      Please include non-medical questions and correspondence only.
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    Office Hours

    Monday: 9am-5pm
    Tuesday: 9am-5pm
    Wednesday: 1pm-5pm
    Thursday: 9am-5pm
    Friday: 9am-5pm
    Saturday-Sunday: Closed

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