Madrid – Spain

+34 912 468 664
+34 627 396 322

Monday – Friday: 11:30 – 19:00 (CET/CEST)
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 – 17:30 (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 and contact details

    Biological sex (for medical assessment)

    2. Requested treatment and preferences

    Where would you like to have the treatment?

    Which service do you need?

    Which area would you like to restore?

    3. Medical history and assessment photographs

    Have you had a previous hair transplant?

    Are you currently using any of these medications?

    Please send us photographs of the angles shown below (only if requesting an online medical assessment) so our medical team can evaluate your case:

    Photographic angles for hair assessment

    Image upload (you can select multiple photos directly from your phone or computer):

    Accepted formats: jpg, jpeg, png, gif, pdf, or zip (maximum total size: 20 MB).

    BASIC INFORMATION ON DATA PROTECTION · DR. ESPINOSA CUSTODIO HAIR MEDICINE
    Controller: Hiram Abif Espinosa Custodio, Instituto Médico del Prado. Purpose: To process and manage your request for information or medical hair assessment and respond to your inquiries. Legal basis: Consent of the data subject. Recipients: Data will not be shared with third parties except under legal obligation. Rights: You may exercise your rights of access, rectification, erasure, objection, restriction, and portability by writing to info@drespinosacustodio.com.