For a limited time we're offering you the choice of a $500.00 credit towards any of our services or No Money Down No Interest financing for 12 months when you take the time to fill in the form below for a free Online Hair restoration consultation with Surehair International's renowned hair transplant surgeon Dr. Nelson Ferreira.

It's our way of saying thank you for giving us the opportunity to assess your hair restoration needs.

Simply fill out the form below and a Sure Hair representative will contact you Online to:

1. Help you assess your options

2. Provide you with pricing details

3. Answer all of your questions

If you elect to use any of our services you will get an instant $500.00 credit to use towards any of our hair restoration services, including hair transplants.

Please Note: All information that you provide us will be held in the strictest confidence and will *not* be sold or shared with anyone for any reason whatsoever. This credit does not apply towards the hair regrowth program.

-------- Online Consultation form ------- Your Basic Contact Information: *Required First Name: Last Name: City: Province/State: Postal/Zip Code: Email: Street address: Optional Contact Information: *Optional Telephone: Hair loss information: *Required Years experiencing hair loss? How old are you? Have you ever had a hair transplant before? No Yes Do you wear a hair piece/system? No Yes According to the chart below which stage of Hair loss most closely resembles your own stage of Hair loss? Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 How much knowledge do you feel you have about the options available to treat your hair loss? very little moderate extensive What type of hair loss treatment are you most interested in obtaining? Surgical - Hair Transplants Cosmetic - Hair System Hair Regrowth Treatments Have you consulted with a dermatologist or another Hair loss clinic about your hair loss condition? No Yes What is the natural color of your hair? Brown Light Brown Black Blond Dark Blond White Salt & Pepper What is your natural hair texture? Medium Medium Coarse Coarse Fine Very Fine Is your hair straight, wavy or curly Straight Wavy Very Wavy Curly Which of the following would you find most helpful in helping you decide on a treatment or course of action? In depth consultation with a Sure Hair representative Meeting with and talking to a previous client Viewing before and after pictures of previous clients Meeting a current client during surgical procedure What day of the week would be most convenient for you to come in for a free consultation? Thursday Friday Saturday Monday Tuesday Wednesday If you require financing which of the following options would you be most interested in? Choose an option if financing is required Option #1: Nothing down and no interest for 6 months Option #2: Minimal down and no interest for 12 months Which of our office locations would you prefer to visit for your consultation? Please Select Toronto Mississuaga Hamilton Kitchener London Long distance clients Optional comments: *Optional Please use the text area below to address any additional questions or concerns you may have regarding the restoration of your hair. (ie: cost, surgical techniques, desired final appearance, etc.)