Call 1300 GROW HAIR (toll free)

The Crown Clinic: Specialists in surgical and non-surgical hair restoration

Online Consultation Form

All information submitted with this form will be dealt with in the strictest confidence.

Contact details - Fields marked with an asterisk (*) are required.

First Name*
Last Name*
Street Address
City/Suburb
State
Postcode
Mobile
Home Phone
Work Phone
Fax
Email*
How would you prefer to be contacted?

Hair-loss details - Fields marked with an asterisk (*) are required.

Areas of Interest*	General Enquiry TwinSkin™ Non-Surgical System Hair Loss Medications Hair Transplant Surgery Nido® Synthetic Hair Implants Scalp Roller Aftercare Products
Gender*
Age*
How long have you been experiencing hair loss?*	years months
Where are you experiencing hair loss?*	Temples Crown On top All over
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Contact details

Our Clinic is open Monday to Friday 9.30am to 5pm:

Toll Free	1300 GROW HAIR
Phone	(02) 9252 0262
Fax	(02) 9252 0263
Email	send an enquiry

We are located in the heart of Sydney's specialist medical area:
British Medical Association Building
Suite 503, Level 5
135 Macquarie Street
Sydney NSW 2000