Online Photo Consultation Cosmetique Lahore Pakistan

Online Photo Conslutation

If you would like to have a photo consultation with our doctors please complete the form, and upload photo or email us.


Tell us how to get in touch with you:



E-mail (Again)



Cell Phone

Age At Which Your Hair Loss Began:    

Date Of Birth:

 ( DD / MM / YYYY )

Current Age:



Male    Female

Relevant Medical History Or One That Might Affect Hair Transplant Surgery ( Such As Diabetes ):

Previous Hair Transplant Procedures Or Other Types Of Their Restoration Surgery. Please Indicate Type Of Procedures And Date (If Known).

How Did You Hear About Us:

Any Question/Other Details:

Attach Photos (Front View, Side Views, Back View)

 ( All Photos Must Be in .jpg or gif Format )

Attach File:
Attach File:
Attach File:
Attach File:
Valid Attachment Types: .zip, .rar, .txt, .doc, .jpg, .png, .gif, .odt, .xml
Max size per file: 1024 kb.
Max combined file size: 2048 kb.


--------------------------    Member Of    --------------------------
like button wordpress themes Cosmetique On You Tube Cosmetique On Facebook Cosmetique On twitter Cosmetique On instagram Cosmetique On linkedin Cosmetique On Wordpress
Dr. Azim J. Khan
Online Appointment Request
Online Photo Consultation
How To Choose The Best Doctor!
Why Choose Cosmetique?