Free eyelash transplant procedure

“Free Eyelash Transplant”
October, 2006, Los Angeles
ISHRS Regional Live Surgery Workshop
co-hosted by Dr. Alan Bauman
over 40 physician attendees

As one of the few surgeons worldwide who routinely performs Eyelash Transplantation, Dr. Bauman has been asked to demonstrate his eyelash transplantation technique in an upcoming ISHRS Regional Live Surgery Workshop, scheduled to be held in October, 2006 in Los Angeles, California. In attendance will be an international physician-only audience of approximately 40 physicians. Dr. Bauman is the only surgeon from North America who is scheduled to perform Eyelash Transplantation at this workshop. At least one patient will be selected by Dr. Bauman from a group of pre-qualified applicants to undergo the procedure. Interested and qualified applicants will be required to pre-register for a medical consultation appointment in Los Angeles prior to the workshop. A very limited number of consultation time-slots are available and will be filled on a first-come, first-served basis to qualified applicants. At least one patient will be personally selected by Dr. Bauman to undergo the eyelash transplant procedure at no charge, valued at US$6,000. For more info about the procedure, please read eyelash transplant facts.

Free Eyelash Transplant Procedure
October 2006, Los Angeles
Screening Questionnaire
PRIVACY PROTECTED
Information will only be used by Bauman Medical for selecting the right candidates for the
free eyelash transplant procedure. We do not sell or share your information with third parties.

All Questions Must Be Answered, click SUBMIT when completed.

Are you male / female?

Age?

Available for an in-person medical evaluation on Sunday, October 23^rdin Los Angeles ?

Available for eyelash transplantation on Monday, October 24^thin Los Angeles ?

Available for post-operative follow-up appointment on Tuesday, October 25^thin Los Angeles?

Do you have scalp hair length >4inches in the back of your head?

Are you willing to sign a ‘photography release’ form allowing publishing/presenting of photos/video of yourself and the procedure for educational purposes?

Do you suffer from Alopecia Universalis, Alopecia Totalis, Active Trichotillomania (hair pulling)?

List all active and inactive medical conditions:

List all prescription medications, over-the-counter medications, vitamins, herbs and supplements you routinely take:

Have you ever suffered from or have been treated for substance abuse or dependence? Explain.

List all previous surgical procedures:

Can you provide your own transportation to and from the clinic in Los Angeles on the day of your procedure (you will not be allowed to drive yourself)?

Can you provide your own local accommodations in Los Angeles
(if applicable)?

What is your current eyelash status? Why are you interested in the eyelash transplant procedure?

Are you able to provide three photos: 1) full face, 2) upper face close-up, 3) back of head if you are selected for the free procedure?

Your full name - privacy protected

Address - privacy protected

Telephone number - privacy protected

Email address - privacy protected

PRIVACY PROTECTED
Information will only be used by Bauman Medical for selecting the right candidates for the
free eyelash transplant procedure. We do not sell or share your information with third parties.

Any questions, please email HairSite@aol.com

Sponsors
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