Registration Form

Please provide us with the following information so that we may contact you to set up a consultation with Prof. Song Jianxing . If you live outside Shanghai (including citys of SuZhou, WuXi,NanJing and HangZhou) and are unable to come in for an evaluation for a surgical transplant, you can use our photo consultation form.

* First Name:
* Last Name:
* E-mail:
* Daytime Phone:
* Gender	Male Female
	Prof. Song Jianxing, M.D.
* How did you hear about us? ( Please select one at least! )
Hair Restoration Network Hair Loss Help Hair Transplantation Network Tongji University Google Friends Family Follicular Unite Forum
* What do you need?
* Required fields

---

If you have any questions about the Shanghai Center for Hair Transplant, or about hair trans-plants, follicular unit grafts, or anything else, please don't hesitate to contact us.

---