Step 1 of 4

Your Information

Can’t make it to our office in Englewood, NJ? Not a problem! Dr. Feinberg offers online hair loss consultations.

100% Confidentiality. Please fill out the form below with as much information as possible. Dr. Feinberg will review your information and contact you directly with a personalized response.

While online consultations are available, Dr. Feinberg prefers consultations at his office. In-person examinations are ideal because they allow the doctor to better evaluate your hair loss. If you are local to the metropolitan area, please contact us to schedule your in-person consultation. 

Step 2 of 4

Hair / Health Profile

Complete the fields below to give us a better idea of your current health status. 

Step 3 of 4

3. Your Hair Transplant

Complete the fields below to give us a better idea of how your hair loss has progressed and what stage of hair loss you’re at currently.

Front Photo Upload*
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Top Photo Upload*
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Left Photo Upload*
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Right Photo Upload*
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Back Photo Upload*
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Step 4 of 4

Confirm Your Submission

Thanks for providing us with your information. Please review and click submit:

  • First name:
    Value
  • Last name:
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  • Email:
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  • Phone:
    Value
  • DOB
    Value
    Value
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  • Occupation:
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  • Address:
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  • Address 2:
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  • City:
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  • State:
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  • Zip Code:
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  • Country:
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  • Age of hair loss:
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  • Propecia?
    Value
  • Rogaine?
    Value
  • Medications?
    Value
  • Pre-existing conditions?
    Value
  • Do you smoke?
    Value
  • Have you had a hair transplant before?
    Value
  • When do you plan on getting treatment?
    Value
  • Hair loss in your family:
    Value
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