Call Today For A Free Consultation 1-800-990-4247

Virtual Consultation

Pacific Hair Institute offers the option of virtual consultation.

Download Form

*You can download in PDF format and email at another time. The form includes a medical history as well as asks you for photos of your head. Please follow the instructions for taking the photos – the better and more clear that they are, the better we can determine your needs.

FAX:    (657) 394-0087
MAIL:    3140 Redhill Avenue, Suite 260, Costa Mesa, CA 92626
TEXT:    (949) 220-4160 (phone pics)
DEBRA:    Office iPhone (949) 423-5950 cell for text

Privacy Notice. Your photos are never posted where the public can see them. all photos submitted to us are held in strict confidence as part of your medical record. Any patient whose photos appear on the website have given us their permission and signed a model´s release.