Tele Trichology

Online Consultation - Hair related problems

Please fill the below form, provide detailed information on existing medical condition, past medical history, current/past medications and attach available scan reports and pictures preferably high quality images as it would help our physicians to examine your ailment(s) with more clarity.

(Step 1 of 4) Basic Information


New / Old Patient

(Step 2 of 4) Let us know about your hair problems and duration of the condition


Do you have patchy hair loss?
Do you have dandruff?
Do you have hair breakage / split ends?
Any Significant illness in the Past one Year

(Step 3 of 4) Tell us know more about your general health and wellness

Do you have anaemia (Low Haemoglobin)?
Do you have a Thyroid Disorder?
Have you lost significant weight in the past one year?
Do you work night shifts?
Co Existing Medical / Surgical Conditions

Current medications / Previous treatment details

(Step 4 of 4) Send your images and relevant documents

Please provide high quality pictures as it would help our physicians to examine your ailment(s) with more clarity.
(Please upload maximum of 1MB files only, all inclusive.)
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(Please upload maximum of 1MB files only, all inclusive.)
Add More
(Please upload maximum of 1MB files only, all inclusive.)
Add More
(Please upload maximum of 1MB files only, all inclusive.)