Contact

Get in touch.

We'd love to hear from you! Fill out the form below and our team will reach out to you later today.
01

The Clinic

Belfast / BT7 1LH
Address
77 Botanic Avenue
Belfast BT7 1LH
Northern Ireland
Telephone
028 9096 4731
Message
Message on WhatsApp
Follow
02

Consultation Enquiry

Confidential / clinical intake
Your details
Sex *
Your concerns
Have you given birth within the last 6 months?
Medical history

Food, medication, known deficiencies (e.g. iron, vitamin D), allergies, intolerances, thyroid. Please give details.

Including contraceptives.

Have you had a blood test in the last 6 months?

Please bring the results to your appointment, or email them to info@hairlosstreatment-belfast.com. Attaching a file here is a reminder for you — it isn't sent with the form.

The information you share here is treated in confidence and used only to prepare for your consultation.