Freedom Hair Systems - Hair Loss Solutions, Esthetics, and Hair Consultation


Thank you for your interest in our Elite Hair Replacement Program. Our Elite Program is like no other. It involves only the most natural looking hair replacement systems and complete ongoing care so you always look your best.
How long have you been losing your hair for?
Has the rate of hair loss increased in the past year?		YesNo
Norwood Grade: (Click to view grades)
Do you suffer from any of the following?
Do you have any family members (father, uncle, grandfather) who has suffered from hair loss?		YesNo
Have you ever attempted any of the following (check as many that apply)?		Rogaine* Finasteride (Propecia, Proscar etc.) Weaves Transplants (or other surgical)

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Privacy Statement: The personal inforation collected here is for Freedom Hair System's professional consultants in order to help determine your eligablity for the free trial promotion. This information will not be sold or given out to anyone without prior permission of the submitter. Freedom Hair Systems keeps it's clients in touch with the latest discoveries, important developments and special promotions in the hair loss and hair replacement areas through our newsletter: "The Hair News". To opt out of receiving "The Hair News", please click the following button: