Hair Transplant

Let's get started ...

Get Ready to Upload Your Photos! We will need photos of your front view, top view and each side view.

To give you an accurate quote, we'll need a few photos from you. Make sure you have them ready to upload when you finish this form.

Not sure what we need? Take a quick look at our photo guidelines before you get started!

https://info.trimup.co.nz/photos-page

First Name *

Last Name *

Email *

Phone *

Date of birth (DD/MM/YYYY) *

Gender *

Male

Female

Other

Height (cm) *

Weight (kg) *

Previous Surgery *

Yes

No

Details of Previous Surgery *

If no previous surgeries type 'none'.

Provide detail of any health issues you have selected above. *

If no other health issues type 'None'.

Do you have any other health issues not listed above?

If no other health issues type 'None'.

What medications do you currently take? *

Please provide medication details and dosage. If no medications type 'None'.

Have you been hospitalised, had surgery or received medical care within the past 5 years (including cosmetic surgery)? *

If you have not been hospitalised type 'None'.

Do you have implants or metal objects in your body? Please specify *

If no metal objects or implants type 'None'.

Do you have any allergies to food, drugs etc? *

If no issues type 'None'.

List all vitamins or food/nutritional supplements you currently take and dosage. *

If you don't take any vitamins or supplements type 'None'.

Have you ever taken daily coumadin, heparin or aspirin? *

Yes

No

Do you smoke or vape? *

Yes

No

Do you drink alcohol? *

Yes

No

Please upload your photos *

To give you an accurate quote, we'll need a few photos from you. These will need to be your front view, back view and each side view. If you need further details on the photos click the link at the top of this form.