Hair Transplant - Natural Results

Your personalised medical evaluation starts here

At Fuecapilar, every treatment is carefully reviewed by our doctors to ensure the highest standards of safety and results.

Please complete the questionnaire below so our medical team can assess your case and approve the next step.

👉 Once approved, we will proceed with confirming your surgery date.

Full Name *

Phone *

Nationality *

Passport expiry date *

Date Of Birth *

Weight *

Height *

Allergic reaction to anesthesia *

Asthma/Emphysema or breathing difficulties *

Blood transfusion *

Cancer *

Dermatologic pathology on the skin (Dermatitis, scaling, folliculitis, tendency to hypertrophic scars or keloids) *

Diabetes *

Heart disease *

Hepatitis A / B / C (even if you have received treatment, please indicate when you were diagnosed as further tests will be required before your trip) *

High blood pressure *

HIV (even if your viral load is undetectable) *

Infarction (necrosis) *

Nervous disorder *

Thyroid disease *

Any medication or treatment you are currently taking *

Please indicate if you are allergic to any medication *

Do you take any type of medication to prevent hair loss? *

Are you a smoker? Please indicate how many cigarettes you smoke per day *

Do you drink alcohol? Please indicate the amount consumed *