514 620-4222
514 666-2438
Français

ABOUT US
HAIR LOSS
HAIRSTYLE
CARE
- Aesthetic
- Massage Therapy
CONTACT

Select Page

VIRTUAL CONSULTATION FOR HAIR HEALTH PROBLEMS

Use our hair problems virtual consultation to get advice about your hair problem. Fill in all the fields and we will get back to you as soon as possible. A quick and discreet solution.

Language

First Name *

Last Name *

E-mail address *

Address

City, Province, Postal Code

Ex.: Montreal, Quebec, H9X 2L9

Phone number - Home

Ex.: 514-123-1234

Other phone number or mobile

Best time to contact you

How where you referred to Clinique Mon Cheveu/Discrétion?

Friend
Internet
Billboard
Radio ad
Magazine
Newspapers
Hospitals
Television
By Mail
Other

What are your expectations?

Stop my hair loss
Have more hair
Treat a specific problem
Other

WOMEN: Which pattern most closely matches your hair loss situation?

A
B
C
D
E
F
G
H
I

MEN: Which pattern most closely matches your hair loss situation?

1
2
3
4
5
6
7
8
9
10
11

Have you ever tried to do anything about your hair loss? (check all that apply)

Rogaine/Propecia
Transplant
Laser therapy
Wigs
Natural products
Hair replacement
Other

What is your motivation to solve your hair loss? (check all that apply)

I look older that I am
I feel older that I am
I want to regain confidence
I want to regain self-esteem
I want to feel better at work
I want to please and seduce

Did you feel that your hair loss prohibits you from being "who you really are"?

Yes
No

Are you ready to do something about your hair loss situation now?

Yes
No
I'm not sure
I'm only looking at my options
Other

Who support your decision?

Friends
Wife/Husband
Children
Family
Nobody

On a scale from 1 to 10, rate the urgency to treat your hair loss (10 being most urgent).

1
2
3
4
5
6
7
8
9
10

Website

Do not hesitate to contact us by phone by consulting the Contact page if you have any questions for us. We will be happy to answer your questions.

ABOUT US | Clinique Mon Cheveu/Discrétion is a complete facility dedicated to meeting your every need for hair care and specialized treatments. You will be welcomed in a prestigious environment with a warm atmosphere. The specialists of the capillary image of Clinique Mon Cheveu/Discrétion provide all the care intended to remedy all the capillary deficiencies, from the prevention of the problems until their correction. The owners of the place, Sylvie and Ronald, will personally look after you.

3303, boul. Chèvremont,
Montréal (Québec)
H9C 2L9

514 620-4222
514 666-2438
info@moncheveu.com

Copyright © Clinique Mon Cheveu/Discrétion | Politique de confidentialité - Privacy Policy