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頭皮/髮問題 預約諮詢
針對您的頭皮/髮問題進行初步諮詢
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* Indicates required question
Email
*
Your email
姓名
*
Your answer
性別
*
Choose
男
女
出生日期 (民國年/月/日)
*
Your answer
聯絡電話
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Your answer
方便聯繫您的時間 (可複選)
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早上 9:30~12:00
下午 1:00~6:00
晚上 6:30~9:00
Required
LINE ID
*
Your answer
1. 請簡述您的頭皮/髮問題 例:落髮/雄性禿/壓力禿/老化/產後落髮/頭皮出汗/油/痘/乾/癢/脫屑/泛紅敏感/髮質受損/頭髮易斷/易打結/毛躁粗糙/染燙受損...等問題)
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Your answer
2. 以上頭皮/髮問題的狀況持續多久?
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Your answer
3.曾經做過什麼治療?
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Your answer
4.是否可接受以下項目 (可複選)
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健保治療
自費生髮藥品
自費育髮療程
自費照光
自費植髮
頭皮紋繡 (擬真繡髮)
Required
備註:
Your answer
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