Madrid – Spain

+34 912 468 664
+34 627 396 322

Monday – Friday: 11:30 am to 7:00 pm GMT+2
Healthcare Registration No. CS16663

Instituto Médico del Prado
Calle Moreto, 5 Bajo Izq.
28014 Madrid – Spain

Mexico City

+52 55 4590 9909

Monday – Friday: 9:00 am to 5:30 pm GMT-6
COFEPRIS 2409135036X00306

Instituto Médico del Prado
Calle Leibnitz, 20, 4th floor
11590 Colonia Anzures, Del. Miguel Hidalgo, CDMX

Hair Evaluation Form

For any inquiries or to request an appointment, please fill out the form and we will get back to you as soon as possible.

    1. Personal Information & Contact

    Sex

    2. Service Request & Preferences

    Where would you like to perform the treatment?

    What service do you need?

    Which zone do you want to recover?

    3. Medical Background & Pictures

    Did you have a previous hair transplant?

    Do you use any of these medications currently?

    Please send us six images, as shown below, so that the Doctor can evaluate your case.

    Perspectives

    Image upload:

    (It is advisable to upload the images in a ZIP file)


    You can upload files in the following formats: pdf, zip, jpg, jpeg, png, gif, with a maximum size of 20MB.

    BASIC DATA PROTECTION INFORMATION FOR MEDICINA CAPILAR DR. ESPINOSA CUSTODIO

    Data Controller: Hiram Abif Espinosa Custodio, Instituto Médico del Prado. Purpose: To process and manage your request, answer your medical or informative queries and, where appropriate, send you communications related to our hair medicine services. Legitimation: Consent of the interested party. Recipients: Your data will not be disclosed to third parties unless required by law. In case of international transfers, your data may be processed in Spain and/or Mexico by the controller under equal protection guarantees. Rights: You may exercise your rights of access, rectification, cancellation, objection, limitation of processing and data portability, as well as revoke your consent at any time by emailing info@drespinosacustodio.com. Additional information: You can consult full details on how we process your data in our Privacy Policy.