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Online Consultation

Thank you for your interest in a hair restoration consultation with Dr. Verret, facial plastic surgeon in the North Dallas suburb of Plano, TX. Please read and answer each of the questions as this will give Dr. Verret a better idea of how to assist you in your search for a more youthful head of hair. When you are done, please click submit and your answers will be forwarded to Dr. Verret. Realize that while we make every effort to maintain the confidentiality of internet communications there is a small risk of others obtaining this information. If you would prefer, you may print and fax this questionnaire to Dr. Verret at 972.473.7828

Gender: Male Female

Does anyone in your family suffer from hair loss? (Check all that apply)

What part of your hair bothers you?

Please check the box that most closely matches your hair.

Hair Loss
Hair Restoration
Hair Transplant
Hair Transplant
Hair Treatment
Hair Loss
Hair Transplant
Hair Transplant
Hair Transplant
Hair Transplant
Hair Transplant
Hair Transplant

Hair Diagnosis History

I have been evaluated by a physician for my hair loss.
I have a diagnosed medical cause for hair loss.
If yes, please describe your condition:

What treatments have you received?

Herbal Supplements
Laser therapy
Hair Transplantation
Hair Extensions
Creative Hairstyling
Other: Please Specify

What are your goals for hair restoration? (Check all that apply)

/ maintain current coverage
previous procedure

Please select the procedure(s) you are interested in pursuing?

Where are you in the process? (check all that apply)

While we attempt our best to maintain the confidentiality of online communications, please realize that these communications are not completely secure. By pressing submit, you understand this. If you wish, you may print out this form and fax it to Dr. Verret at his office fax 972.473.7828.

By clicking submit, you acknowledge our e-mail policies and agree to our e-mail consent for use.

Dr. D.J. Verret is certified by the American Board of Facial Plastic & Reconstructive Surgery and the American Board of Otolaryngology, Head & Neck Surgery and certified by the American Board of Facial Plastic & Reconstructive Surgery, is a member of the prestigious International Society of Hair Restoration Surgeons and the American Academy of Facial Plastic & Reconstructive Surgery, and a clinical assistant professor at the University of Texas Southwestern Medical Center. His hair restoration center focusses on natural and long lasting results for people suffering from hair loss. For hair restoration, hair transplants, Dallas hair loss treatments, eyebrow restoration, eyebrow transplants, treatment for male pattern baldness, and treatment for female pattern baldness, consider Dr. Verret. Common misspellings of Dr. Verret's name include Verrett, Verrette, Varret, Verette, Veret, Varratte, Verette, Verrett, and Ferret. Click here for our disclaimer and terms of use.