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萌髮診所 - 植髮諮詢
請填入下方基本資料，吳文藝醫師收到資料後會親自與您聯繫!
Please fill in the basic information below. Dr. Wu Wen-Yi will personally contact you once the information is received.
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* Indicates required question
請留意吳醫師加入您好友的訊息或來電，再拍下照片發給吳醫師，才能進行線上初步評估喔!
Please pay attention to messages or calls from Dr. Wu adding you as a friend. Then, take a photo and send it to Dr. Wu for an initial online assessment.
請選擇要諮詢的項目
Consultation subject
*
植髮 Hair transplantation
植眉 Eyebrow transplantation
植鬍 Beard transplantation
疤痕植髮 Scar hair transplantation
Required
以下有哪些是您頭髮目前的情況?
（ Select the current condition of your hair）
*
頭頂禿髮 Balding crown
M型禿髮 M-pattern baldness
髮際線高 High hairline
頭髮稀疏 Thinning hair
大面積禿髮 Extensive baldness
其他 Other
Required
姓名 Name
*
Your answer
性別 Gender
*
男 Male
女 Female
Required
年齡 Age
*
Your answer
請勾選您的線上聯絡方式
( Please select your online contact method.）
*
Line
what's app
wechat 微信
Required
請填入上方勾選的號碼或ID
( Please enter the number or ID selected above. )
*
Your answer
電話 Phone number
*
Your answer
方便與您聯繫的時間
（ Preferred contact hours ）
9:00 - 14:00
14:00 - 19:00
18:00 - 22:00
Other:
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